Columbia Adult School Transition (CAST) Program Application Form
Student Information
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Age
College Educational Goal
Needs Assessment (Check all that apply)
Disability Services
Formerly Incarcerated
Vocational Training
Career Services
Financial Aid
Child Care
Mental Health Services
Food Bank
Veterans
Tutoring
Housing
Foster Youth
Student Signature- I declare under penalty of perjury that the information on this form is true and correct to the best of my knowledge.
*
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Adult School Education Information
Adult School Name
*
Adult School Teacher/Instructor
*
Program Type
*
Please Select
GED
Hi-Set
High School Diploma
Adult Ed School Enrollment Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Estimated Completion Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Adult School Certification
The CAST program is made possible by Senate Bill 554 (Roth, 2019). This legislation allows adultschool students to attend community college tuition free (up to 11 units per term) provided they are actively pursuing a high school diploma or high school equivalency with an adult school. Your signature on this form certifies that this student is actively pursuing their high school completionthrough your adult school. Each term that this student continues to participate in CAST, the adult school will be asked to recertify the student’s participation in their high school program in order to qualify for CAST services.
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Adult School Designee Signature
*
Adult School Designee Name and Title
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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