GED Online
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Enrollment Form

IMPORTANT: Please be sure to read the Enrollment Procedures before filling out this form.

GED Online is password protected; therefore, you must first enroll in the program before you can begin class. There is no cost to enroll, but you MUST be a Missouri resident. Please fill out the following form and an instructor will contact you within 5-7 business days with information about getting started.

Fields marked with an asterisk (*) are required.

I would like to enroll in:
*First Name
*Last Name
*Address
*City
State Missouri
*Zip
*Phone
Additional Phone Number
*E-mail
Enrollments with invalid email addresses will not be processed
*Social Security Number (123456789, no dashes)
*Date of Birth (mm/dd/yyyy)
*Are you currently enrolled in High School? Yes No
*Grade Last Completed
*Sex
*Race
*Have you previously been enrolled in GED classes? Yes No
*Do you have a computer at home with internet access? Yes No
If not, where do you plan on using a computer?
*How did you learn about GED online?
*Labor force status Employed
Unemployed
Not In Labor Force
*Mark all categories that apply
Immigrant Adult
On Public Assistance
Low Income
Dislocated Worker
Single Parent
State Correctional Facility 		Disabled Adult
Learning Disabled Adult
Homeless Adult
Live in Rural Area
Displaced Homemaker
Probation and Parole
Local Correctional Facility
*Primary Goal
*Secondary Goal
*Have you taken a TABE test in the last 90 days? Yes No

If Yes, please provide the following:

Location and approximate date test was taken:

Instructor's Full Name:
*Have you read and do you agree with the GED Online Policies? Yes No
Please give us a brief background about yourself:

 

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