New Student Enrollment Form

Hello there! We are excited that you want to join our free classes. Before we can get started, we need to know a little about you. That is the purpose of this quick survey! You will start by enrolling in classes with our Student Specialist, Amy, and then, at a later date you will complete an initial assessment that allows us to customize your studies so you reach your goals faster.

Complete this form to schedule a date and time to enroll in classes with Amy. Remember, you have the leading role in this process! If your information changes or you need to reschedule an appointment, reach out to us as soon as possible. We are here for you, and all of our services are free of charge!

"*" indicates required fields

Unique ID

What is your county of residence?*

We have proudly served Southwest Virginia and the surrounding communities for over 30 years!

Your Address*

Address Address Line 2 City State ZIP Code

It looks like you are from an area that is outside of our region. We recommend looking for an adult education provider close to you. If you are in Virginia, we suggest this page from the Virginia Department of Education website.

If you are from another state, we recommend entering your location into this map from the GED Testing Service website.

If you are having trouble finding a local program or would like to talk to us relating to your specific situation, please call us at (276)-386-2433, Monday-Friday 8AM to 4:30PM.

Contact Information

Your Name*

First Last

Your Email

Enter Email Confirm Email

Your Phone Number*

What phone number should Amy call?

Is the above phone number a cell phone number?*

Yes

May we text you via this number if needed?*

Yes

Do you have access to the internet at home?*

Yes

Do you have access to a device at home (smartphone, tablet, laptop/desktop/Chromebook)?*

Yes

Enrollment Appointment Information

Enrollment Appointment Date*

What is a good day that Amy can call you to get you enrolled? (Monday-Friday)

MM slash DD slash YYYY

Enrollment Appointment Time*

What is a good time that Amy can call you to get you enrolled? (Please allow up to 15 minutes after the time you selected in the event that Amy is working with another student and cannot call at the exact time you selected.)

Please make sure the selected date is not a past date. Thanks!

Your Rights & Student Information

Please read the below statements and select if you agree.

Your Student Rights:

Regional Adult & Career Education (MyRACE1) is committed to a policy of non-discrimination and follows federal laws to protect your student education records also known as Family Educational Rights and Privacy Act of 1974 (FERPA).

You can read more about FERPA here: Department of Education - Family Educational Rights and Privacy Act

I agree that I have been notified about my FERPA rights

By selecting the "I Agree" option, you are signing this Notification of FERPA Rights statement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Notification of FERPA Rights statement.

Release of Student Information

I agree to allow Regional Adult & Career Education to release my directory information to the local community college and/or to workforce agencies at my local Virginia Career Works to determine if I qualify for additional workforce-related assistance, including occupation-specific education and training benefits. This signed release expires at the end of my enrollment in the current program year.

I agree to the Release of Student Information.

By selecting the "I Agree" option, you are signing this Release of Student Information statement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Release of Student Information statement.

This field is for validation purposes and should be left unchanged.

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*GED and the GED Testing Service are registered trademarks of the American Council of Education and may not be used or reproduced without the express written permission of the ACE.

Privacy, FERPA and Non-Discrimination

General Education Provisions Act (GEPA)

RACE 1 is updating this website to ensure compliance with Section 504 of the Rehabilitation Act and Title II of the Americans with Disabilities Act. In the interim, website accessibility concerns may be brought to the attention of Bryan Smith, Director of Technology for RACE 1 at bsmith@myrace1.org.