EmailMeForm
MOLearns Application FY25
Fill out the form carefully to register for MOLearns. All information on the application is kept confidential.
The MOLearns program provides FREE online classes for adult students. Classes are ongoing, and new students are added to classes every two weeks. All students are required to have current placement tests on file prior to beginning classes. You will get an email with information about testing within a week of completing your application.
State Requirements:
* Must be a Missouri resident and have a Missouri mailing address
* Cannot be enrolled in high school
* Cannot hold a F1 Visa
* Must be at least 17 years of age or older
Program Requirements:
• Missouri Photo ID with birthdate and Missouri address
• TABE placement testing prior to beginning online
• TABE post-testing after 40 hours of online work
• Minimum of five hours of online lessons per week
• Communication with the teacher weekly
• Computer less than five years old
• Computer with speakers & camera - no phones
• Reliable high-speed internet
• Chrome browser installed
Unique ID
MOLearns requirements
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I agree
I disagree
I am 17 years of age or older and no longer enrolled in high school.
I am a resident of the state of Missouri.
I have a valid photo ID with my birthdate and a Missouri address.
Create a Username
You may not use profanity (bad language) in your username or password or your account will not be accepted.
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Create a username with 8 characters (letters and/or numbers only).
Write this username down for future reference.
Confirm Username
Create a Password
You may not use profanity (bad language) in your username or password or your account will not be accepted.
*
Create a password with 8 characters (letters and/or numbers only).
Write this password down for future reference.
Confirm Password
Student Information
Social Security Number
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(please enter numbers only, no dashes)
Legal Name
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First
Middle
Last
Preferred Name, if it is different from your legal name
First
Last
Email
*
Confirm Email
Address
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Street Address
City
State / Province / Region
Postal / Zip Code
Birthdate
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MM
/
DD
/
YYYY
Sex
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Female
Male
Non-Binary or Other
Gender Identity
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Man
Woman
Gender Fluid
Gender Nonconforming
Gender Queer
Nonbinary
Transgender
Two-Spirit
Other
Prefer Not to Disclose
Prefered Pronoun
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He
She
They
Cell Phone Number
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-
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-
####
Home Phone Number
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-
###
-
####
Work Phone Number
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-
###
-
####
Demographics
You must indicate if you are Hispanic and also choose yes or no for each race listed.
Are you Hispanic?
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Yes
No
Select Yes or No for each. You must mark yes for at least one race.
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Yes
No
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Education & Employment Status
Highest Level of Education
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Grades 1-5
Grades 6-8
Grades 9-12 (no diploma)
Secondary School Diploma or Alternate Credential
Secondary School Equivalent
Some Postsecondary Education, No Degree
Postsecondary or Professional Degree
Unknown
Location of highest level of education
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U.S. Based Schooling
Non U.S. Based Schooling
Barriers to Employment
You must indicate yes or no for each statement.
Barriers to Employment You must choose yes or no for each. You must mark yes for at least one barrier.
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Yes
No
Cultural Barriers
Disabled
Displaced Homemaker
Low Income
English Language Learner
Ex Offender
Exhausting TANF within Two Years
Foster Care Youth
Homeless
Long Term Unemployment
Less than 12th Grade Education
Migrant Farmworker
Seasonal Farmworker
Single Parent or Guardian
Additional Information: Select yes or no for each question.
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Yes
No
Public Assistance
Dislocated Worker
Minor with Adult Status
Immigrant
Apparent or Disclosed Disability
Employment Status
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Employed
Unemployed
Not in Labor Force
Employed with Separation Notice
Additional Information
Which of the following do you have at home? This information will allow us to contact you and/or connect you to services.
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Yes
No
I have a computer with a camera.
I have a computer without a camera.
I have a webcam.
I have a headset with a microphone.
I have a cell phone.
I have a home phone.
I have internet access.
I have a printer.
I have a scanner.
Please indicate if you are a student working with a Job Center Agency, a hybrid student attending a classroom, or share any additional educational information, such as a learning disability, IEP or 504.
TABE Placement Test
Have you taken a TABE test in the last six months?
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Yes
No
What was the date and location of your last TABE test. Please indicate the classroom location and if you know the approximate date.
Have you passed any of the subtests on the HiSET or GED Exam? Check all that apply
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Reading
Science
Social Studies
Math
Writing
None
Have you previously been a student in MOLearns?
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Yes
No
If you have been a student with MOLearns in the past, please list approximate date when you were last enrolled.
Are you receiving services through WIOA(Workforce Investment Opportunity Act)?
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Yes
No
If yes, which program?
Title I Adult
Title I Dislocated Worker
Title 1 Youth
Title III Wagner-Peyser
Title IV Vocational Rehabilitation
None
MOLearns Class Policy Agreement
Please read and agree to each statement.
MOLearns Class Policy Agreement
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I agree
I disagree
I must complete TABE placement tests prior to beginning online.
I must have a computer/laptop or Chromebook less than five years old with the latest version of Chrome installed.
My computer must have speakers/headphones and a camera.
I must have reliable high speed internet.
I must complete my assigned lessons each week.
Regular participation is important so that learning and progress can take place.
I must take a TABE post-test when my teacher feels it is necessary.
I must notify my teacher by email if I am unable to meet my weekly hours for an extended period of time.
I must communicate with my online teacher via email on a regular basis (at least once a week).
I certify that the information given on this application is true and accurate to the best of my knowledge and belief. I consent to the release of my records maintained by a state or local education agency, including the information on this form and transcripts, grades, certificates, the High School Equivalency, and diplomas earned by me. This information may be used by the Missouri Department of Elementary and Secondary Education and shared with other state agencies for research and reporting purposes. Data shared between agencies includes, but is not limited to, employment, additional schooling, and follow-up services provided to you by agencies identified in the Workforce Innovation and Opportunity Act (2014). I certify that I am not currently enrolled in high school or hold an F1 Visa.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.
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Please type your full name as your signature. I certify to the best of my knowledge and belief that the answers given are true, complete, and accurate.
