Bellefonte Area School District
High School Diploma Program for Adults
1. Complete the
application (please answer all questions).
2. Mail application to Jeanne Harvey, Bellefonte Area School District, 318 N. Allegheny Street, Bellefonte, PA 16823
3. You must be at least 21 years of age.
(Last) (First) (M.I.) (Social Security #)
(Street) (Apt. #) (City) (State) (Zip)
Phone: Home____________ Work____________ Emergency Number____________
Personal Data: Date of Birth___________________ Age____ __Male __Female
Names of Children:
__________________ Age____ __________________ Age____
___________________ Age____ __________________ Age____
Are you a citizen of the
United States of America? ____
In which school district do you reside? _________________________
Education: Name of last school attended _________________________ Attended from ______ to _____
Completed_______ Reason for leaving
Have you ever taken and passed a GED test? ____Yes _____No If yes, when___________
How did you learn about the
“High School Diploma Program for Adults?”____________________________
Do you have any family members/friends taking this program? If yes, who? ____________________________
Name and Address of Employer: _______________________________________________
Title_______________________ Type of Employment________________ Date of
Name of Supervisor_____________________
Please answer the
following questions (in paragraph form) on the back of this sheet:
Why are you interested in earning a high school diploma?
How might you see your life change as a result of earning your diploma?