Enroll – Pathways Adult Learning Center

STUDENT INFORMATION
Parent/Guardian Name*
Parent/Guardian Address*
City*
State*
Zip Code*
Parent/ Guardian Phone Number*
Parent/Guardian Email*
Student Name*
Date of Birth*
MM slash DD slash YYYY
Please name student's disability/disabilities*
- Autism Spectrum Disorder
- Down Syndrome
- Cerebral Palsy
- Fragile X
- MR
- Williams Syndrome
- Other
How did you hear about Pathways?*
You may choose in-person classes, virtual classes, or a combination of both in-person and virtual classes. What type of classes would you be interested in learning more about?*
Please answer the following questions. Your answers to these questions will not exclude your prospective student from admission, but will help us determine follow up questions and enrollment options for consideration during the interview process.
Is the prospective student able to care for his or her personal needs in the restroom?*
Is the prospective student able to feed his or her self without support?*
Is the prospective student able to administer any required medications independently?*
Does the prospective student have a history of exhibiting behavior that may be harmful to themselves or others and/or significantly disruptive to other students in a classroom setting?*

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