KANSEL GED Prep Program Enrollment Application NameDate of BirthMonthDayYearDate of BirthEmail AddressPhoneStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountySedgwickHarveyRenoKingmanButlerHarperSumnerCowleyOtherGenderMaleFemaleRaceWhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian and Other Pacific IslanderTwo more more racesOtherNot KnownEthnicityHispanic of LatinoNon HispanicNot KnownAre you currently employed?YesNoPlace of EmploymentCurrent Annual IncomeLess than $10,000$10,000-14,999$15,000-$24,999$25,000-$34,999$35,000-$49,999$50,000-$74,999Greater than $75,000Desired Class TimeMorningsEveningsOnline Last School AttendedHighest Grade CompletedLess than 9th9th10th11th12thEmergency Contact NameEmergency Contact Email AddressEmergency Contact PhoneEmergency Contact Street AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCompulsory Education Disclaimer: Pursuant with K.S.A 72-1111, all KANSEL students under 18 must present a "Compulsory School Attendance Disclaimer"I am an under 18 and I understand I need a Compulsory Education Disclaimer. I understand that I must this disclaimer before beginning the GED Program.I am over 18, this does not apply to meGED Testing Service Identification Policy: You will be required to provide one or more valid forms or identification on the day of your test. The ID must government issued and non-expired. It must also include your name, address, date of birth, signature, and photograph.I understandCertification and SignatureI have read read the application in its entirety and certify that all information is true and correct to the best of my knowledge.Type Name for SignatureDateSend Message
