*required field

Date of Birth



High school diplomaGEDSpecial education/ IEP diplomaSome college, no degreeCollege or professional degreeTrade schoolNo schooling
I am disabledI am an immigrantI am learning disabledI am a single parentI am in-between jobs
All programs, policies, and services of the Crawford County School for Adult Education will be administered without discrimination in regard to race, color, religion, national origin, sex, age, sexual orientation, or handicap status.

Release of information

By participating in the Crawford County School for Adult Education, I agree to the release of information and the request for information contained in my program records, including, but not limited to, assessment results and attendance, to the Pennsylvania Department of Education if required, and to or from cooperating agencies, to meet my individual needs. I give permission to take photographs of me for the purpose of display in the CCSAE suite, web site, promotional materials, local media, and Facebook, as well as projects and/or photo albums.

Please type your name to digitally sign the application

Please use the MM/DD/YYYY format

What technology do you have available? ________cell phone _________computer __________Zoom possibility __________Google Duo_________ Face Book___________ Messenger video____________ Texting___________ Wi_Fi__________


Do you have transportation to our school for classes? ____________daytime ___________evening