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Academic Training Verification

Home » Parents & Families » Academic Training Verification

- Step 1 of 2

Personal Information

Parent Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Specialist Name

Source of Income

Source of Income

Unemployment
Child Support
Other

Unemployment $

Child Support $

Other

Other $

Academic Goal

Main Education or Training Goal

Prepare for a new career (acquire new job skills)
Advance in current job/career (update job skills)
Improve Basic skills in English, Reading or Math
Complete credits for High School Diploma/GED
Obtain a Vocational Certificate
Obtain a two-year Vocational Degree
Obtain a two-year Associate Degree
Obtain a Bachelor's Degree
Obtain a Master's Degree
Maintain a certificate or license
Other

Other (Please Specify)

Field of Study

Career goal upon completing education

School Information

School Name

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Date Current Term Begins

Date Current Term Ends

Expected Date of Completion

Class Schedule(s)

Course Name

Course Number

Units

Days

M
T
W
Th
F

Time In

Time Out

Course Name 2

Course Number (Course 2)

Units (Course 2)

Days (Course 2)

M
T
W
Th
F

Time In (Course 2)

Time Out (Course 2)

Course Name 3

Course Number (Course 3)

Units (Course 3)

Days (Course 3)

M
T
W
Th
F

Time In (Course 3)

Time Out (Course 3)

Course Name 4

Course Number (Course 4)

Units (Course 4)

Days (Course 4)

M
T
W
Th
F

Time In (Course 4)

Time Out (Course 4)

Course Name 5

Course Number (Course 5)

Units (Course 5)

Days (Course 5)

M
T
W
Th
F

Time In (Course 5)

Time Out (Course 5)

Failed Course/Courses to be Repeated

Course Name

Grade

Class Start Date

Class End Date

Course Name 2

Grade (Course 2)

Class Start Date (Course 2)

Class End Date (Course 2)

Course Name 3

Grade (Course 3)

Class Start Date (Course 3)

Class End Date (Course 3)

Course Name 4

Grade (Course 4)

Class Start Date (Course 4)

Class End Date (Course 4)

Additional Information

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