High School Diploma Preparation Program

Hudson County Schools of Technology
Earl W. Byrd Center
525 Montgomery Street
Jersey City NJ 07302

Email: ksullivan@hcstonline.org
Office: 201-631-6348
Text: 201-241-1180

{purposeOf}
School Year Application
Date of Application*

MonthDayYear
Purpose of application*
Student Information
SSN*
Date of Birth*

MonthDayYear
Current Age*
Gender*
Student's Name*

First NameLast Name
Address*

Street Address

Apartment or Suite #

CityState

Zip Code
County*
Best Reach Phone Number*
Please enter a valid phone number we can reach you
Alternative Phone Number
Email Address*
Please enter a valid email address we can reach you
Do you have a secondary email we can contact you?*
Secondary Email*
Please enter a valid email address we can reach you
Ethnic Heritage
Ethnic Heritage*

Hispanic or LatinoNot Hispanic or LatinoI choose not to disclose
Race*

AsianAlaskan/American IndianWhiteBlack/African AmericanHawaiian/Pacific IslanderI choose not to disclose
School Status
School Status*
In-School Status*
Not Attending School Status*
Name of the Last School You Attended*
City of the Last School You Attended*
State of the Last School You Attended*
Education Level
Education Status*
Choose highest level only
Last Grade Completed*
Employment Status
Employment Status*
Are you working?*
Support*
Family First Case #*
Your Family First Case # must start with a C and then 9 digits!
US Citizen
Are you a US Citizen?*
Alien Registration #*
Permanent Resident Expiration Date*

MonthDayYear
Individual with Disability
Individual with Disability Status*
Selective Service
Selective Service*
Selective Service Number*
Native Language
Native Language*
Other Native Language*
Driver's License
Do you have a Driver's License?*
Please select the State*
Emergency Contact
How many emergency contacts would you like to submit?*
Emergency Contact #1
Emergency Contact #1 Name*

First NameLast Name
Emergency Contact #1 Relationship*

AuntBrotherCousinFatherFoster ParentFriendGrandfatherGrandmotherGuardianMotherNeighborSisterStepfatherStepmotherUncleOther
Emergency Contact #1 Phone Number*
Please enter a valid phone number.
Emergency Contact #1 Email*
Emergency Contact #2
Emergency Contact #2 Name*

First NameLast Name
Emergency Contact #2 Relationship*

AuntBrotherCousinFatherFoster ParentFriendGrandfatherGrandmotherGuardianMotherNeighborSisterStepfatherStepmotherUncleOther
Emergency Contact #2 Phone Number*
Please enter a valid phone number.
Emergency Contact #2 Email*
Emergency Contact #3
Emergency Contact #3 Name*

First NameLast Name
Emergency Contact #3 Relationship*

AuntBrotherCousinFatherFoster ParentFriendGrandfatherGrandmotherGuardianMotherNeighborSisterStepfatherStepmotherUncleOther
Emergency Contact #3 Phone Number*
Please enter a valid phone number.
Emergency Contact #3 Email*
Survey
How did you hear about us?*

Search engine (Google, Yahoo, etc.)Recommended by friend or colleagueSocial mediaOther
Interested in Postsecondary Training?*
What training would you be interested in? (Select all that applies)*

Advanced Wastewater OperationsAuto Mechanics BasicsCarpentry BasicsCCMA - Certified Clinical Medical AssistantCert Administrative Professional AssistantCertified Medical Administrative Assistant (Voucher Included)Clinical Dental Assistant (Voucher Included)CompTIA A+ Certification (Voucher Included)CompTIA IT Fundamentals (Voucher Included)Cosmetology & HairstylingCulinary ArtsEKG & PhlebotomyElectricity AdvancedElectricityESLForkliftHandyman SpecialistHealth is Wealth FitnessHVACIntro to Law and the Legal SystemIntro to Water/WastewaterMedical Assistant w/PhlebotomyMedical Billing and Coding (Voucher Included)Microsoft Excel 2019 Certification TrainingMicrosoft Office SuiteMicrosoft Word 2019 Certification TrainingMindfulness & Meditation Through ArtworkMultimedia Marketing and DesignOSHA 30 TrainingPlumbing AdvancedPlumbing BasicsProfessional Bookkeeping w/Quickbooks 2019 (Voucher Included)Real EstateTeacher Assistant CertificationTeacher's Aide w/Parapro PrepWastewater Collection Systems Operation & MaintenanceWeldingOther
Required Documents

You can take a picture with your phone and upload the documents.
Proof of ID #1 - Please select an option from the drop down list*
Proof of ID #1 - Document*

Cancelof
Proof of ID #2 - Social Security Card*

Cancelof
Proof of ID #3 - Photo ID*

Cancelof
Proof of ID #4 - Proof of Address (Must be within 30 days)*

Cancelof
Signature

I attest that the information provided is true and accurate. Any misrepresentation may be grounds for termination from program(s). I also understand that being eligible for services and/or training does not necessarily entitle me to service/training.
Signature*

Clear
Parent/Guardian Name (if applicant is under 18)*

First NameLast Name
Parent/Guardian Signature (if under 18)*

Clear
Should be Empty:

Hudson County Schools of Technology

Student Information

Ethnic Heritage

School Status

Education Level

Employment Status

US Citizen

Individual with Disability

Selective Service

Native Language

Driver's License

Emergency Contact

Emergency Contact #1

Emergency Contact #2

Emergency Contact #3

Survey

Required Documents

Signature