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breadcrumbs: Adult Diploma Completion Program: breadcrumbs: Learning Center Enrollment


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Smoky Hill Learning Center Enrollment


First:     Last:

Address:     City:     

State:     Zip:

E-mail  Address:

Home Phone:     Cell Phone:

Birth Date:     Age:    

 Gender: M F     Ethnicity:

Have you graduated from high school? Yes No

Sponsoring School District:     

Graduation year:

Location you will be attending:

AbileneBellevilleConcordiaHaysSalina Other

Emergency Contact Name:

Emergency Contact Phone:

How/where did you hear about the Smoky Hill Learning Center?

Internet Friend Advertisement School Other

Required Documents

  • Transcripts from all previous schools attended
  • Official photo identification - REQUIRED FOR ALL STUDENTS


Student Signature:     Date:




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