Student Enrollment Form

The Excel Center is like a big key that can open lots of doors for you. We help adults just like you earn their high school diploma. Once you have that diploma, things start to change. You can feel proud when telling people about your school. You might even be able to get a better job or go to college. And the best part? You start to see how strong and determined you really are. With a high school diploma from The Excel Center, you can show everyone, including yourself, that you can achieve anything.

Student Information

First Name

Last Name

Maiden/Previous Name

Date of Birth

Is student 18 year of age or olderYesNo

Student SexMaleFemale

Address

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Student Phone Number

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Student Email Address

Complete This Section If Student Is Under 18

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Relationship

Parent/Guardian Phone Number

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Parent/Guardian Email Address

General Inquiry Questions

Registration Questions

Do you or your parents have a first language other than English?YesNo

Is the student Hispanic or Latino?YesNo

What is student's ethnicity?American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite or Caucasian

If applicable, what is the name of the most recent high school the student attended?

Are you listed on any federal or state sexual offender registry?YesNo

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No school owned or operated by Goodwill Education Initiatives, Inc., discriminates on the basis of race, religion, gender, color, national or ethnic origin, and disability in administration of its educational policies, admissions policies, scholarships or other Excel Center-administered programs.