APPLICATION FOR ADMISSION TO HIGH SCHOOL EQUIVALENCY
TESTING PROGRAM
(To be filed with the Regional Superintendent of the County
in which the applicant has maintained residence. Applicant
must pay a $15.00 fee for GED Examination and $10.00 for the
issuance of the High School Equivalency Certificate.)
1. NAME (Last-First-Middle-Maiden) |Male|Female|
2. PRESENT ADDRESS (No.,Street,City,Zip Code,County)
3. ILLINOIS ADDRESS (No.,Street,City,Zip Code,County)
4. HEIGHT
5. WEIGHT
6. COLOR OF EYES
7. COLOR OF HAIR
8. DATE OF APPLICATION
9. PHONE NUMBER
10. DATE OF BIRTH
11. SOCIAL SECURITY NO.
12. PLACE OF BIRTH
City or Town State
14. ARE YOU A RESIDENT OF THE STATE OF ILLINOIS?
15. ARE YOU AGE 18 OR OLDER?
16. HAS YOUR HIGH SCHOOL CLASS GRADUATED?
17. MONTH AND YEAR YOU LAST ATTENDED SCHOOL
18. HIGHEST GRADE OF SCHOOL YOU COMPLETED
19. ARE YOU A H.S. GRADUATE?
20. NAME AND ADDRESS OF SCHOOL LAST ATTENDED (City and
State)
21. Did you pass the Constitution examination in H.S.?
WHEN?
NAME OF H.S. (School and City)
22. Have you previously taken the tests of G.E.D.?
WHEN? (Month, Year, Form of Test)
WHERE? (Location and City)
23. REASON FOR TAKING G.E.D.
a. To acquire High School Equivalency Certificate
b. To satisfy request of another agency, such as to
supplement credentials for admission to college, for
enlistment, etc.
IF YOU CHECKED B, TO WHOM IS THE TEST REPORT TO BE SENT?
Agency
__________________________at_____________________
24. Did you take a G.E.D. preparation course?
25. Do you plan to continue your education beyond high
school?
Your signature
APPLICANT IS TO REPORT TO
_________AT_________ON__________
Chief Examiner|GED Center|Time and Date
Agent is notified to send GED Form 28-08
to______________at____________
Issuing Officer
Misc. signatures