North East ISD Distance Learning Application

Please answer all the questions on this form and click the Submit button when you have finished.

Last Name:	First Name:	Middle Name:
Street Address	Apt # (if applicable)	City
State	Zip Code:
Email (Required for distance learning)	Telephone Number with Area Code

Please answer ALL of the following questions:

1. I am interested in:

English as a Second Language (ESL)
GED preparation

2. How many days per week do you have access to a computer?

1-2 days/week
3-4 days/week
5-6 days/week
every day

3. Do you have a computer/laptop with high-speed Internet access at home?

Yes
No

4. What level of experience do you have using computers?

None
Beginning
Intermediate
Advanced

5. How often do you check your email?

Daily
4-6 times/week
3-4 times/week
1-2 times/week
never

6. Do you own a VCR or DVD player?

Yes
No

7. Do you live close to a local library, the Ferrari Learning Center, or North East Community Learning Center?

Yes
No
I don't know

8. If you do NOT live in walking distance from any of the three places mentioned in question 7, do you have reliable transportation to get to one of those places at least twice/month? Please describe.

9. Are you a motivated learner?

Yes
No

10. Can you work on a self-paced curriculum without a lot of teacher guidance?

Yes
No

11. Are you self-disciplined enough to set aside some time to finish your assignments in a timely manner?

Yes
No

12. Are you currently employed?

Yes
No

13. If you answered YES for question 12, how many hours/week do you work?

hours/week

14. Did you take a class with North East ISD, or a different Adult Education program before?

Yes
No

If you answered yes, what program and class?

15. Why do you want to be accepted into the distance learning program, as opposed to traditional face-to-face classes?