Information Technology Summer Session
Personal Information
First Name
*
Middle Name
Last Name
*
Street Address
*
City
*
State
*
Zip
*
Cell Phone Number
*
Email Address
Date of Birth
*
-
Month
-
Day
Year
Date
Do you have any existing health/medical conditions you would like noted in your student profile in case of emergency?
*
Yes
No
Please explain the health/medical condition.
*
Do you have any physical impairments that might be a barrier to you successfully completing this program?
*
Yes
No
If so, please explain the physical impairment:
*
Skills and Certifications
In what languages are you proficient? Check all that apply:
*
English
Spanish
Chinese
Tagalog
Vietnamese
Cambodian
Korean
Hmong
Arabic
Russian
Farsi
Somali
Other
How would you rate your computer skill level?
*
Never used a computer
Beginner
Competent
Highly Proficient
Have you earned your high school diploma or GED within or outside the United States?
*
Yes
No
Are you currently enrolled in a High School Diploma or GED program?
*
Yes
No
Program Referral
Were you referred to Bakersfield Adult School by any of the following programs/agencies? Check all that apply:
*
America’s Job Center of California (AJCC)
Career Resource Department (CRD) / F Street
Dream Center
EPIC
Kennemer/Turning Point
Kern County Department of Human Services
Kern County Employers’ Training Resource
Kern County Department of Rehabilitation
None of those
Other
Employment
Do you have any prior employment experience related to the program you are applying for?
*
Yes
No
Briefly describe your experience:
*
How do you plan to use the skills you get in this program in the future?
*
Student Accepted
Please Select
Pending
Yes
No
Submit
Should be Empty: