AEFL Adult Student Intake Form

Please complete the form below. Required fields marked with an asterisk *

Contact Information for AEFL Adult Student Form

If you answered OTHER above, please tell us how you heard about SouthernTech's AEFL Adult Program.

Answer Required

First Name*

Answer Required

Last Name*

Answer Required

Date of Birth*

Answer Required

Street Address*

Answer Required

City*

Answer Required

County*

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Zip/Postal*

Answer Required

Home Phone

Number Required

Mobile Phone

Number Required

Email*

Answer Required

Student Information

Have you ever been enrolled in Adult Education Classes?*

Answer Required

Yes

Have you ever taken an HSE (High School Equivalency) Exam?*

Answer Required

Yes

Last High School Attended*

Answer Required

Please Read:

I understand that my personal information will be input into LACES (Literacy, Adult and Community Education System) which is the Oklahoma AEFL online student data management system. This system is utilized to track student performance, student outcome and maintain federal requirements of the grant funded program.

I acknowledge and understand the purpose of my data being input into LACES.*

Answer Required

Yes

Please fix the highlighted areas below before submitting.

AEFL Adult Student Intake Form

Contact Information for AEFL Adult Student Form

Student Information

Please Read: