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Let's Celebrate!

We love celebrating your accomplishments with you!

Please complete the form below to share your success and inspire future students just like you!

Name(Required)

First Last

Cell Phone(Required)

Email(Required)

Date of Birth(Required)

Month

Day

Year

Age(Required)

What accomplishment(s) are you celebrating?(Required)

I increased a level on my test!

I tested out of English class and into HSE classes!

I am a new US citizen!

I earned my High School Equivalency (HSE) diploma!

I earned a career training certification!

I got a new job or promotion!

Check all that apply.

Which career certification did you complete?(Required)

Congrats on your job! Tell us a little more about it!(Required)

Would you like to attend a graduation ceremony in your honor?(Required)

*Future date, location, and time for our next graduation ceremony will be announced later this year.

Yes

No

Please let us know how many guests you would like to invite to share in this special day!(Required)

1

2

3

4

5

6

Please let us know what size graduation gown you will need:(Required)

S/M/L/XL

XXL/XXXL

Please select your height range so that we know which graduation gown length you will need:(Required)

4’11” – 5’1″

5’2″ – 5’4″

5’5″ – 5’7″

5’8″ – 5’10”

5’11” – 6’1″

6’2″ – 6’4″

6’5″ – 6’6″

Please tell us about how Park Vermillion Adult Education and/or its staff has positively impacted your life.(Required)

Would you like to upload a favorite picture of yourself for our slideshow?(Required)

Yes

No

Upload your picture here:(Required)

Max. file size: 512 MB.

PHOTO RELEASE(Required)

Please check the statement below to give us permission to use your photo.

I give permission for Park Vermillion Adult Education to use my name and/or picture in online or print promotional communication.

PERMISSION TO SHARE(Required)

Please check the statement below to give us permission to share your story in our slideshow.

I give permission for Park Vermillion Adult Education to use my name and/or the above words I shared in online or print promotional communication.

Signature:(Required)

Please type your full name as it appears on legal documents to give consent and serve as your electronic signature.

Date(Required)

MM slash DD slash YYYY

Parent/Guardian Signature:(Required)

Please type your full name as it appears on legal documents to give consent and serve as your electronic signature.

Date(Required)

MM slash DD slash YYYY

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