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Virtual Tour
Search for:
Search
Search for:
Virtual Tours
Belleville Campus Virtual Tour
Sam Wolf Granite City Campus Virtual Tour
Red Bud Campus Virtual Tour
Information for...
High School Students
Prospective Students
Current Students
Former Students
About
Board of Trustees
Campuses
College Profile
Offices
Academics
Academic Standards
College Catalog
Find A Program
Find a Course
Online Learning
Career Degrees
Career Certificates
Transfer Degrees
Career Pathways
College Policies
Adult Education and Literacy
Community
Belleville AmeriCorps
Community Education
Foundation
Library
The Schmidt Art Center
Senior Programs
Career & Employer Services
Life at SWIC
Athletics
Blue Storm Radio
College Activities
Student Handbook
SWICarts
SWIC Dining Options
Student Services
Advising
SWIC Bookstore
Career Services
Enrollment Services
Library
Paying For College
Public Safety
Records
Success Center
Support Services
SWIC-Cares About You!
Testing Centers
Contact
Belleville Campus
Sam Wolf Granite City Campus
Red Bud Campus
East St Louis Campus
PSOP Campus
Scott Air Force Base Campus
Fire Science Campus
Off Campus Sites
General Contact at SWIC
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> Adult Education Registration Form
Adult Education Registration Form
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Adult Education Registration Form
Name
*
Select one
Mr.
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Gender
*
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SSN
*
If you do not have a social security number you must enter xxx-xx-xxxx
Primary Phone
*
Phone Type
*
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Campus
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Secondary Phone
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Permanent Address
*
Street Address
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Is your permanent address is the same as your mailing address?
*
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Mailing Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
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Military
*
Enlisted Active Duty
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National Guard
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None
Citizenship Status
*
U.S. Citizen
Permanent Resident
In U.S. on a VISA
Other
Exp. Date
Month
Day
Year
VISA Country
Visa Type
High School Status
*
I have received a high school diploma
I have received a High School Equivalency (25000098)
I have not received a high school diploma or HSE
Not Applicable
Year you began High School
Last grade completed
High School Status: The last high school I attended was
in another state
in another country
another high school in Illinois
(HSE completers need not respond)
List State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
School Name
(If home schooled use 25000099)
The last high school I attended was one found below:
Select one
Althoff (25000001)
Alton (25000002)
Assumption (25001181)
Belleville East (25000004)
Belleville West (25000005)
Cahokia (25000007)
Central Cmty, Breese (25000008)
Chester (25000009)
Christ Our Savior Lutheran High School (25000010)
Civic Memorial (25000011)
Collinsville (25000475)
Columbia (25000014)
Coulterville (25000015)
Dupo (25000016)
E. Alton-Wood River (25000017)
East St. Louis (25000019)
Edwardsville (25000020)
Freeburg (25000021)
Gibault (25000022)
Governor French Academy (25000023)
Granite City (25000024)
Highland (25000025)
Lebanon (25000026)
Livingston (25000027)
Lovejoy (25000028)
Madison (25000029)
Marissa (25000030)
Mascoutah (25000031)
Mater Dei (25000032)
Nashville (25000033)
New Athens (25000034)
O’Fallon (25000035)
Okawville (25000036)
Red Bud (25000037)
Roxana (25000038)
SIUE East St. Louis Charter (25000018)
Sparta (25000039)
Steeleville (25000040)
Triad (25000041)
Valmeyer (25000042)
Venice (25000043)
Waterloo (25000044)
Wesclin (25000045)
Not in this list
Are you currently enrolled at McKendree?
Yes
No
Last college attended
was in Illinois
was in another state
was in another country
credit earned in the military
Admit Term
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Year
Residency
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Residency District
(Out-Of-District Students Only) List the Illinois Community College District of Residency
Enrollment Status
*
First-time student (first-time summer students are also classified first-time in fall)
Transfer student (earned college credit at another college, first term at SWIC)
Continuing student (enrolled at SWIC the previous term) or Re-admitted student (prior SWIC enrollment, not previous term)
Employment Status
*
Employed full time
Employed part time (over 15 hours)
Employed part time (15 hours or less)
Homemaker
Unemployed
Other
No response
Are you Hispanic or Latino?
*
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No
Please identify student's primary racial/ethnic group
*
American Indian or Alaska Native
Asian
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White
Hispanic / Latino
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Are you a single parent?
Yes
No
No response
Out-of-workforce individual?
Yes
No
No response
First generation (Do either of your parents have a bachelor's degree?)
Neither one does
Yes, one does
Yes, both do
No response
Parent Active Duty Military
Yes
No
No response
Disability?
Not disabled
Documented disability (ADA)
Choose not to respond
Do you live in?
Rural Area
Urban area with high unemployment
Neither
Barriers to employment
English language learner, low literacy level, cultural barriers
Displaced homemaker
Individual with disability
ex-offender
Exhausting TANF within two years
Veteran
Long term unemployed
Migrant/seasonal farmworker
low income
single parent
homeless person/runaway youth
not applicable
Number of dependents
Do you receive public assistance?
Yes
No
Do you participate in any of the following?
Community Correctional Program
Correctional Facility
Other institutional setting
Early School Leavers Program
Family Literacy Program
Volunteer Literacy Program
None are applicable
How did you hear about this program?
One Stop
Employer
Social Media
SWIC Website
Other
Consent
*
I certify the above information provided is complete and correct. I understand that if I withhold or give false information on this form it may make me ineligible for enrollment to the college or subject me to dismissal.
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Adult Literacy Tutoring Program
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Education to Careers
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High School Diploma Test Preparation Classes (Formerly GED/HSE Classes)
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High School Diploma Testing Information
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Highway Construction Careers Training Program
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Vocational Classes
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