Application for Enrollment – Documents not Required Step 1 of 9 11% Program OverviewWelcome to Hope Training Academy Adult Education. Our mission is to serve students who want to advance their career through computer training and certifications. We have classes, locations, and times to fit your unique learning needs. Confidential Application For EnrollmentLet's Create a Brighter Future Together! FREE Money for IT Education and CertificationsPlease select your program of interest:(Required) CompTIA A+ Full Name(Required) First Middle Last Date of Birth(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student InformationAddress(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County(Required) Best Phone Number to Reach You(Required)Best E-Mail to Contact You(Required) Please enter your referral code If you received a referral code, please enter it here.Preferred Pronoun If you have a preferred pronoun, please enter it here. Student Information (continued)Social Security Number(Required) (required by the State of Indiana to determine eligibility)Gender(Required) Male Female Other Ethnicity(Required) Hispanic or Latino Not Hispanic or Latino Race: (Check all that apply)(Required) African American-Black American Indian-Alaskan Native Asian or Pacific Islander White-Not Hispanic Hawaiian-Other Pacific Islander Do not wish to answer Country of Birth:(Required) Native CountryDo you require bilingual or translated courses?(Required) Yes No What language do you need? Active Military?(Required) Yes No Retired Military?(Required) Yes No Are you a US Citizen?(Required) Yes No Employment InformationWhich Best Describes Your Employment Status?(Required) Employed/Self-Employed Not employed but seeking employment Not in labor force (disabled, retired, etc.) Employed but about to lose my job Unemployed more than 6 months If you are working, where do you work? (Skip if not working)When did you start working there?Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920(Skip if not working) Educational InformationHighest level of education achieved?(Required) No schooling Grades 1-5 Grades 6-8 Grades 9-12 (no diploma) High School Diploma / Alternative Credential HSE (High School Equivalency) / GED Some college (no degree) Associate's degree Bachelor's degree Masters degree or beyond Degree from Foreign Country, not college Are you attending school now?(Required) Yes No Where did you last go to school?(Required) Household InformationHow many people are in your household?(Required)Estimated annual household income?(Required)(Before taxes) How did you hear about our program? (Check all that apply) Brochure/Flyer Court Referral Department of Workforce Development adulted.info website Employer Friend/Relative Newspaper Public Assistance Referral Shelter TV/Radio WorkOne referral Robocall Social Media (Facebook, Instagram, Twitter, etc.) Other Release of InformationI am enrolled in an adult education (AE) program. This AE program works with the following programs and agencies to help students improve their skills and earn better jobs: • Other state-funded adult education programs • WorkOne offices and job training programs • Public and private colleges • State executive offices, departments, and agencies including the Indiana Department of Workforce Development (DWD), Division of Adult Education and the Indiana Department of Education. By signing below, I understand and agree to the following: • The information on my intake form is correct. • DWD use of directory information (name, address, birth, and social security number) to match test score records, wage information, and college/training program enrollment records that assist the state to evaluate and improve its programs and to report results to the federal and state government. • The sharing of information between the agencies and programs listed above. This information may include my name, enrollment information, education/career goals, test scores, and employment history. The information will be kept strictly confidential and will be used for program administration, research, and evaluation purposes.I agree to the above information Yes Signature(Required)Please sign your full name.Photo ReleaseI give permission for Hope Training Academy to use my name and photo in online or print promotional communications.(Required) Yes No SignaturePlease sign your full name. Addressing Barriers to Your EducationSometimes as adult students, we have barriers that keep us from being able to focus on education. At Hope Training Academy, we have a team of life coaches who are ready to provide resources that can help you with those barriers. Please fill out the form below to let us know how we can help!Please let us know about any barriers you have that we can help you with. Do you need help with any of these barriers? Impairment (physical) Impairment (mental) Impairment (learning) Impairment (hearing) Live in urban area (city) Live in rural area (out of city) Receive public assistance Low income Single parent Displaced homemaker Dislocated worker I am a dependent I have dependents I am a foster care youth Homeless/Runaway Use foreign language (not English) Active/Retired military/reserve Vocational rehabilitation Wagener-Peyser employment Migrant/Seasonal farm work Ex-offender Cultural issues with employment I don’t have any of these barriers at this time. Check all that apply:
