* 1. What is your first name?

* 2. What is your last name?

* 4. How many credits do you require to have a completed grade 12 or GED equivalent ?

* 5. Are you currently employed?

* 6. If you are employed please select which describes your position,

* 7. What is your job title?

* 8. Are you interested in obtaining your grade 12 credits while you work?

* 9. Are you interested in obtaining 2 to 3 credits towards a College Diploma?

* 10. If you were to obtain post secondary credits please check which course you would be interested in,

* 11. Are you registered as a member of Lac des Mille Lacs First Nation?

* 12. If interested in this adult education opportunity, are you available to start in January 2015 in this program?

* 13. Would you like to be contacted for more information regarding this opportunity?

* 14. Please provide contact information, if you wish to participate in the program.

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