Please enable JavaScript in your browser to complete this form.Personal Information Name *FirstMiddleLastEmail *Phone *Type of Phone *Please select an optionMobileHomeWorkPlease upload a recent full face photo. Click or drag a file to this area to upload. Passport Type PhotoUpload Completed PDF HESEAP Application * Click or drag a file to this area to upload. In order to qualify for the HESEAP fast track Bachelor Degree Program, you must hereby swear and vow that you have been actively involved in educational activities for the past four years, spent time in personal study, attended and actively participated in educational events, and lastly, you have a minimum of four years experience teaching others and learning. *I hereby swear under oath, and vow, that I qualify as described aboveNo, I do not qualifyI declare under oath that, the foregoing claims and information I have disclosed are true and accurate. *AgreeStatement of Nondiscriminatory Policy as to Students *I acknowledge that I have read and understand the “Statement of Nondiscriminatory Policy as to Students”NONDISCRIMINATORY POLICY: USILACS does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers and vendors, enrollment of students, and provision of all services. We are committed to providing an inclusive and welcoming environment for all members of our staff, students, volunteers, subcontractors, vendors, and customers. HESEAP Committee Review Fee *Price: $ 129.00Payment Method *StripePaypalIf you select Paypal, you need to click Submit to proceed with payment.Stripe Credit Card *CardName on Card WebsiteSubmit
