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

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

County*

Answer required for "County"

Zip/Postal*

Answer required for "Zip/Postal"

Home Phone

Number Required

Mobile Phone

Number Required

Email*

Answer required for "Email"

Student Information

Have you ever been enrolled in Adult Education Classes?*

Answer required for "Have you ever been enrolled in Adult Education Classes?"

Yes

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

Answer required for "Have you ever taken an HSE (High School Equivalency) Exam?"

Yes

Last High School Attended*

Answer required for "Last High School Attended"

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

Yes

Please fix the highlighted areas below before submitting.

AEFL Adult Student Intake Form

Contact Information for AEFL Adult Student Form

Student Information

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