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Contact Us
Adult Education ENROLLMENT FORM
Name
(Required)
First Name
Last (All) Name(s)
Home Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Please list the address of the residence affected by disaster.
Date of Birth
(Required)
MM slash DD slash YYYY
Gender
(Required)
Male
Female
Phone Number
(Required)
Are you able to receive text messages from CCEOK?
(Required)
Yes
No
Email
(Required)
Employment Status
(Required)
Full-time
Part-time
Unemployed
Not looking for work
Retired
City/State/Country of Birth
(Required)
What was the last grade of school you completed?
(Required)
No School
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade, no diploma
High School Diploma
High School Equivelancy
Some College, no degree
Vocational Certificate
Associate's degree
Bachelor's Degree
Master's Degree
Doctoral Degree
In what city, state, and country were you last enrolled in school?
Which classes would you like to enroll this year? Check all choices.
(Required)
English as a Second Language (all locations)
HiSET (GED) in English (Tulsa)
HiSET (GED) in Spanish (Muskogee/Tulsa)
Basic Computer in Spanish (Tulsa)
Spanish Literacy (Tulsa)
Where would you like to take your classes? Check choice(s).
(Required)
Tulsa ESL (AM classes available only)
Tulsa HiSET (AM and PM available)
Broken Arrow (MOC)
Muskogee
When are you able to attend classes?
(Required)
Mornings
Evenings
Race or Ethnicity. Check all that apply.
(Required)
Latinx
Asian
Black
White
Native Hawaiian or Other Pacific Islander
Native America or Native Alaskan
I prefer not to answer
Name of Emergency Contact
(Required)
Phone Number of Emergency Contact
(Required)
Relationship of Emergency Contact
Spouse
Parent
Sibling
Friend
Child
Co-Worker
Other
What technology do you have access to? Check all that apply.
(Required)
Smart Phone
Smart Tablet
Computer/Laptop
Home Internet/WiFi
None of the above
Why are you enrolling in classes now?
(Required)
Improve myself
My job requires a diploma
Get a better job
Continue my education
Other reason
What is your goal for taking ESL classes?
(Required)
Learn enough to get by
Learn enough to help my kids
Learn enough for my job
Learn enough to get a better job
Continue my education
Become fluent
Other
I am only interested in HiSET classes
Which of the HiSET tests have you passed?
(Required)
Reading
Writing
Science
Social Studies
Math
None, but I have registered on hiset.org
None, and I have NOT registered on hiset.org
I'm not sure
I'm only interested in ESL Classes
When do you hope to graduate?
(Required)
May 2025
May 2026
As soon as I can pass the tests
What will completing these classes do for you and your family?
(Required)
Do you have any barriers that may prevent you from attending class? Check all that apply.
(Required)
Disabled
Learning Disability
Financial Need
Transportation Challenges
Childcare Challenges
Work Schedule
English Language Learner
Ex-Offender
Homeless
Other
None
When are you available to come to the Tulsa Campus for the mandatory ESL diagnostic test?
Tuesday, December 17 from 10:00-10:45am (for am classes only)
Tuesday, December 17 from 6:00-6:45pm (for am classes only)
Tuesday, January 7 from 10:00-10:45am (for am classes only)
Tuesday, January 7 from 6:00-6:45pm (for am classes only)
I cannot make any of these times
You will not be eligible for enrollment in classes until your diagnostic test is completed. Please select a time that you are available to come in and complete the ESL diagnostics. The test will take approximately 30 minutes to complete.
When are you available to come to MOC for the mandatory ESL diagnostic test?
Tuesday, December 10 from 6:00-6:45pm
Tuesday, January 9 from 6:00-6:45pm
I cannot make any of these times
You will not be eligible for enrollment in classes until your diagnostic test is completed. Please select a time that you are available to come in and complete the ESL diagnostics. The test will take approximately 30 minutes to complete.
When are you available to come to the Tulsa Campus for the mandatory HiSET diagnostic test?
Tuesday, December 17 from 9:30am-1:30pm
Tuesday, December 17 from 4:00-8:00pm
Tuesday, January 7 from 9:30am-1:30pm
Tuesday, January 7 from 4:00-8:00pm
I cannot make any of these times
You will not be eligible for enrollment in classes until your diagnostic test is completed. Please select a time that you are available to come in and complete the HiSET diagnostics. There are five subject area tests which will take up to 4 hours to complete.
Photo/Audio/Video Release
(Required)
Yes
No
Catholic Charities of Eastern Oklahoma (CCEOK) often uses photographs, videos and/or audio in its printed and online publications, including newsletters, brochures, displays, newspaper articles, social media and websites. As a client/volunteer of CCEOK, your image or sound bite may be taken during various activities and may be selected for use in any of our publications. The image/sound bite will be used only to promote and positively recognize CCEOK programs. Catholic Charities of Eastern Oklahoma retains all rights to the photographs, videos and audio recordings. Therefore, we would like to obtain your consent to use any images taken of you for this purpose. I give my permission for my photo, video or audio files to be used in any Catholic Charities of Eastern Oklahoma publications, and I agree to the above terms and conditions.
Information Consent
(Required)
I agree to the privacy policy.
By submitting this form, I give permission to the Adult Education program of Catholic Charities of Eastern Oklahoma to share the results of my evaluations and other data as long as my personal information remains anonymous.
Name
This field is for validation purposes and should be left unchanged.
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