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Congratulations on Your Success!

Sharing about your adult education journey can inspire others to pursue success as well. We are honored to celebrate your accomplishments with you!

Please tell us about how adult education is helping you to reach your goals.

"*" indicates required fields

Name*

First Last

Phone*

Date of Birth*

Month

Day

Year

Age*

What accomplishment(s) are you celebrating?*

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.

Would you like to attend a graduation ceremony in your honor?*

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

YES

NO

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

0

1

2

3

4

5

Please let us know what size graduation gown you will need:*

S/M/L/XL

XXL/XXXL

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

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″

Which career training certification did you complete?*

Congrats on your job–tell us more about it!*

Please share a few words about how Mercer Community Education and Training and/or its staff has positively impacted your life.*

Would you like to upload a picture of yourself for our slideshow?*

You can inspire other students just like yourself!

Yes

No

Upload your picture here.*

Max. file size: 2 MB.

Photo Release*

Please check the statement below to acknowledge your agreement for use to use your photo.

I give permission for Mercer Community Education and Training to use my name and picture in online or print promotional communication.

Permission to Share*

Please check the statement below to acknowledge your agreement for use to use your photo.

I give permission for Mercer Community Edcuation and Training to use my name and the above words I shared in online or print promotional communication.

Student Signature*

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

Date

MM slash DD slash YYYY

Parent/Guardian Signature*

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

Date

MM slash DD slash YYYY

Congrats to these successful students!

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