John A. Logan College Center for Workforce Development Registration Form
NOTE: While a social security number is not required for admission to John A. Logan College, it is used as additional verification of student records.
Ethnicity and Race Information:
This information is requested so the institution may demonstrate compliance with federal and state reporting requirements. Your response will not affect your admissions decision.
Are you Hispanic or Latino?
Select one or more of the following races:
This information is required to receive institutional Perkins funding.
Please select the correct statement regarding your parental status:
Are you currently homeless? (defined as lacking fixed, regular, and adequate nighttime residency)
Are you currently unemployed, underemployed, or a displaced homemaker? (defined as an individual who was previously in the workforce or worked in the home)
Are you a youth who is currently in, or have aged out of, the foster care system?
Are you a dependent with a parent who is an active duty member of the armed forces?
Address Line 1
Address Line 2
Home Phone Number
Cell Phone Number
Confirm Email Address
High School Graduation Year:
High School Type:
What is your highest degree earned:
Are you currently employed?
Name of Current Employer:
Please read and check the following statements to indicate your consent.
Your initials certifying confirmation
Ethnicity Number (Auto Populated)