Adult Education Application Form 2022

Thank you for your interest in registering for a funded place on The ENGAGE Programme. Please fill out this survey to finish your application.

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* 1. Your contact info:

First Name

Last Name

Address 1

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. In what year were you born? (enter 4-digit birth year; for example, 1986)

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* 3. What is the highest level of education you have completed?

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* 4. What is your current educational status? (e.g. are you in education and struggling or considering returning to education?)

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* 5. Do you confirm you are over 18 years and Autistic (self-identified or diagnosed)?

Yes

Other (please specify)

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* 6. Do you have any access needs? (Select all that apply.)

I do not have any access needs

I need captions turned on

I need my camera off

I need to use text rather than voice communication

I need a support person to attend sessions with me

I need additional time to process my thoughts

I need access to video recordings

Other (please specify)

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* 7. What would you most like to get out of this programme?

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* 8. How would you like us to contact you?

Text

Both

Adult Education Application Form 2022

Question Title

* 1. Your contact info:

Question Title

* 2. In what year were you born? (enter 4-digit birth year; for example, 1986)

Question Title

* 3. What is the highest level of education you have completed?

Question Title

* 4. What is your current educational status? (e.g. are you in education and struggling or considering returning to education?)

Question Title

* 5. Do you confirm you are over 18 years and Autistic (self-identified or diagnosed)?

Question Title

* 6. Do you have any access needs? (Select all that apply.)

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* 7. What would you most like to get out of this programme?

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* 8. How would you like us to contact you?

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* 9. Do you have any other comments, questions, or concerns?