Welcome to Program Year July 1, 2022 - June 30, 2023

ONLY submit one application per program year.
To update information on an active or to reactivate your application, contact us at 210-432-6123.

#1 - HAVE YOUR DOCUMENTS READY before starting your application.
#2 - DO NOT LOSE ACCESS TO YOUR E-MAIL, the instructions for your next steps will be sent through e-mail. If you can't access your email, contact us at the number above to provide us your new email address.
#3 - APPLICATIONS INACTIVE for more than 60 days will be CLOSED and applicants will have to contact the Intake office at the number provided above to inquire about returning.

Applications with missing documents will be open for four weeks and if pending items are still missing after the four weeks, these will be inactivated.

ADULT EDUCATION & LITERACY STUDENT ENROLLMENT FORM 2022-2023

Today's Date
What program are you interested in?*
Have you attended another adult education class?*

Personal Information

Date of Birth*
MM/DD/YYYY
Gender*
Are you Hispanic/Latino?*
Race*
check all that apply

Identification Information

Do you have a Social Security Number?*
9 number max. Just numbers, NO hyphens
Do you have a Driver's License or State ID?*
Select the of State your ID or DL belongs to. Example. Texas
Enter the ID or DL Number
Other Identification Type*
Provide additional information to the ID Type above


You MUST COMPLETE and upload all of your documentation in order for your application to be processed. You can save and resume this application at the bottom if needed.

If you have any questions about this form, please contact our office at (210) 432-6123 or email us at info@restoreeducation.org


No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
Mandatory for everyone that has a Social Security card and Workforce Training applicants
No File Chosen
File uploads may not work on some mobile devices.
No File Chosen
File uploads may not work on some mobile devices.
Workforce Training. Example. CNA, Admin, Phlebotomy, etc...
No File Chosen
File uploads may not work on some mobile devices.
Ages 16-18 only. If 18 and completed High School, upload your H.S. Diploma.
STAFF ONLY

Contact Information

Address*

ALL enrollment communication, steps, and instructions will be sent to this email address. Please double check for accuracy!
Do you have a cell phone?*
May we text you?*
Do you have a home phone?*
Do you have internet at home?*

Participant Status Upon Program Entry

Equal Opportunity Information

Do you have a physical or mental impairment that substantially limits one or more of your major life activities?*
Participant has, or impairment is primarily*
(if applicable, check any that apply)
Do you have a learning disability?*
Defined as a Learner with an IQ in the low-average and above level (70+ to any level) who has deficits (related to neurological impairments) in capacity in defined limited learning areas; this can include dyslexia (reading disability), dysgraphia (writing disability), and dyscalculia (math disability). The larner also has a history of previous educational efforts.
Category of Learning Disability*
(if applicable, check any that apply)

Veteran Information

Are you currently serving in the United States Armed Forces?*
Have you served in the United States Armed Forces and been discharged or released from such service under conditions other than dishonorable?*
Have you served in the active U.S. military, naval or air service for a period of less than or equal to 180 days, and discharged or released from such service under conditions other than dishonorable? *
Have you served on active duty for a period of more than 180 days and discharged or released with other than a dishonorable discharge; or were you discharged or released because of a service connected disability; or were you a member of a reserve component under an order to active duty, or have you served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge?*
Are you a veteran who served on active duty in the U.S. armed forces are are entitled to compensation regardless of rating (including those rated at 0%); or, except for the receipt of military retirement pay, you would be entitled to compensation, under laws administered by the Department of Veterans Affairs (DVA); or you were discharged or released from activity duty because of a service-connected disability?*
Are you a veteran who served on active duty in the U.S. armed forces are are entitled to compensation (except for the receipt of military retirement pay) under laws administered by the DVA for a disability, (i) rated at 30 percent or more or, (ii) rated at 10 or 20 percent in the case of a veteran who has been determined by DVA to have a serious employment handicap?*
Date of Military Separation*
MM/DD/YYYY
Do you meet any of the following criteria? 1. Spouse of any person who died on active duty or of a service connected disability; 2. Spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S. C 101 and the regulations issued there under, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days: (i) missing in action; (ii) captured in the line of duty by a hostile force; or (iii) forcibly detained or interned in the line of duty by a foreign government or power; 3. Spouse of any person who has a total disability permanent in nature resulting from a service connected disability, or the spouse of a veteran who died while a disability so evaluated was in existence. *

Employment and Education Information

Employment Status*
(check all that apply)
$
Have received notice of termination of employment*
Not Employed for more than 27 consecutive weeks (approx. 7 months)*
Reason for not looking for work*
Select one
(Select one)
Do you live in a rural or urban location?*
A Rural Area is a place of less than 2,500 inhabitants and located outside of urbanized areas
School Status at Program Entry*
Select one
Highest School Grade Completed*
Highest Education Level Completed*
Where did you complete your education?*

Migrant and Seasonal Farmworker Characteristics

Are you a seasonal farmworker whose agricultural labor requires travel to a job site such that makes you unable to return to your permanent place of residence with the same day?*
Are you a low-income individual (i) who for the 12 consecutive months out of the 24 months prior to application for the program involved, has been primarily employed in agriculture or fish farming labor that is characterized by chronic unemployment or underemployment; and (ii) faces multiple barriers to economic self-sufficiency?*
MSFW Youth: Are you a migrant farmworker or seasonal farmworker (as above) aged 14-24?*
Dependent adult: Are you an adult program participant and a dependent of the individual described as a seasonal or migrant seasonal farmworker?*
Dependent youth: Are you a youth program participant and a dependent of the individual described as a seasonal or migrant seasonal farmworker?*

Public Assistance Information

Within the last 12 months have you, or a family member living in your home, received any of the following benefits?*
Select all that apply
Are you eligible for TANF services?*
Will your TANF exhaust within 2 years?*

Additional Reportable Characteristics

Are you, or have you ever been, in foster care?*
Are you homeless?*
Are you low-income?*
Are you an English Language Learner?*
Are you unable to gain employment due to cultural barriers?*
Are you an immigrant?*
Are you a Displaced Homemaker?*
Are you a Dislocated Worker?*
(layoff from job)

Household Information

Number of adults in the household*
Number of minors in the household*
Household Makeup*
Are you a Parent?*
Are you a Single Parent?*
Child(ren) ages:*
Select all that apply
Do you have reliable daycare?*

One Stop Center Program Participant Information

Have you received services under Title 1, Chapter 4, Subtitle C of WIOA?*
WIOA Adult?*
Select one
WIOA Dislocated Worker Terminated, laid off, self-employed without work, displaced homemaker, or spouse of Armed Forces on active duty without employment?*
Select one
WIOA Youth?*
Select one
WIOA Title II, Adult Education?
Mark Yes; Automatically Yes
WIOA Title I, Chapter 4, Subtitle C (Job Corps)?*
Select one
WIOA Vocational Rehabilitation (VR; aka DARS)?*
VR&E: Vocational Rehabilitation and Employment
WIOA Wagner-Peyser Employment Service?*
Select one
Ex: AA-12345-12-55-A-26 (14 Character Grant #) Unknown enter all 9’s | Leave blank = Did not receive

Criminal/Corrections Information

Ex-offender status at Program Entry*
Select one
Date Released from Incarceration
Do you currently reside in one of the following types of facilities?*
Are you currently on parole or probation?*

Additional Program Information

Are you a participant in one of the following programs?*
Were you referred by WSA?*
Were you referred from a college?*
Were you referred by Ready to Work?*
How did you hear about Restore Education?*
Name of the person or agency that referred you.

Additional Information

Do you have reliable transportation to school?*
What is your transportation to school?*
How many hours can you commit to attending per week?*
Would you be the first of the family to attend college?*
$
ONLY include the yearly income earned by you. If you have no income, enter zero.
$
Include the yearly income earned by you and others in your household. If your household has no income, enter zero.
No File Chosen
File uploads may not work on some mobile devices.
REQUIRED for Ready to Work applicants going into Workforce Training.

Primary Goals Upon Program Entry

You must select "Yes" for at least one Primary Goal, but you may select "Yes" for all that apply

Obtain High School Diploma*
Obtain High School Equivalency*
Obtain Job*
Retain Job or Advance in Job*
Enrollment in College or Other Training*

Participant Acknowledgement, Release of Information, and Signature

The information provided is complete and correct to the best of my knowledge. I agree to abide by Adult Education Program policies, rules and regulations. I further understand the submission of false information is grounds for rejection of my application, withdrawal of acceptance, and cancellation of enrollment.


My signature below shall constitute acknowledgement to statistical use of my records of enrollment, progress, credential obtainment, and transition to postsecondary enrollment or employment. My signature below also authorizes use of my personally identifiable information, including my employment and wage information pre-, during and post- enrollment for audit, study and evaluation of the Adult Education and Literacy program performance and other state and federally-funded programs. Such programs may include but are not limited to those under the laws administered by the Texas Education Agency and the Texas Higher Education Coordinating Board.


I acknowledge that the Adult Education and Literacy program and that TWC may release personal identifiable information to other local, state, federal, partners and/or stakeholders for verification of state and federal program requirements, performance reporting, audit, evaluation, study and to monitor the programs performance. Participants who are 17 and 18 years of age must have written parental permission or qualify for another exemption from compulsory attendance law.

Additional information may be found at: http://www.twc.state.tx.us/twc-website-privacy-security-information#confidentiality.


Participants who are 16 through 18 years of age must have written parent/guardian permission to participate in the program. Parents/guardians, by signing below, you are verifying that information on this enrollment form is correct, giving your child permission to be part of our Adult Education program, and acknowledging release of information.


Photo & Video Release

I hereby grant and authorize Restore Education the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Restore Education and will not be returned. I hereby hold harmless, and release Restore Education from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate.


Consent for Case Management - Release

As a student of Restore Education, I agree to participate in the Case Management Program offered by Restore Education and its partners. 

I understand that this means: 

  • A member of the Restore Education staff may contact me or our case management providers and partners to discuss my needs.  Partners may include the San Antonio Hope Center, Nxt Level Youth Opportunity Center, the United Way Dual Gen Program, Good Samaritan Center, Family Services, and other professional organizations that provide wrap around support services and financial assistance to our students.
  • Wrap around services are provided at no cost to me.  This could include childcare, bus passes, emergency financial assistance, parenting classes, and more. It’s my choice to participate. 
  • By my signature below, I authorize the release of my name, phone number, email, and needs for services by the Restore staff to the appropriate partner agency. 
  • I understand that some Restore programs require I participate in job placement case management.  I also understand that non-participation with job placement case management could result in termination from the program. 

This agreement is active while you remain engaged in Restore Education services. 


To sign, are you 19 years of age or older OR 18 years old with a HS diploma/GED?*
Use your mouse or finger to draw your signature above.

Participants who are 16 through 18 years of age must have written parent/guardian permission to participate in the program. Parents/guardians, by signing below, you are verifying that information on this enrollment form is correct, giving your child permission to be part of our Adult Education program, and acknowledging release of information.

Use your mouse or finger to draw your signature above.
No File Chosen
File uploads may not work on some mobile devices.
Required for minor applicants.
Save and Resume Later