Form 6187-03e - Ged Application Form
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General Educational Development – High School Equivalency Program
Department of Post-Secondary Education, Training and Labour
Certification Unit
GED APPLICATION FORM -
6187-03E (2015/10/26)
PLEASE PRINT CLEARLY
Surname :____________________________________ First : _______________________Middle:
Previous Surname
:_______________________________________________________________________________
Complete Mailing Address
Postal Code
:
:______________
Social Insurance Number: _______/_______/_______ Last Grade Completed in Public School:
Date of Birth :
Age:
Tel. (daytime) #: (_____)
______/______/______
year
month
day
Yes
No
Attended a Community Adult Learning Centre?
Yes
No
Followed the GED Online Preparation Program?
Yes
No
Accommodations requested?
CHECK APPROPRIATE BOXES:
First application to write all five (5) tests
Reschedule (applied previously)
Rewrite the following test(s):
Science
Language Arts, Writing
Language Arts, Reading
Social Studies
Mathematics
PREFERRED WRITING LOCATION:
Fredericton
Moncton
Saint John
Miramichi
Woodstock
APPLICANT DECLARATION:
I am at least 19 years of age and no longer enrolled in the public school system.
I did not graduate from high school and do not have high school equivalency.
I hereby certify the above information to be true.
Applicant’s Signature :____________________________________ Date :_______________________
TO BE FILLED IN BY COMMUNITY ADULT LEARNING AND GED ONLINE LEARNERS ONLY:
I give permission to the Certification Unit to release my results to the Community Adult Learning
Services Branch and my teacher and/or mentor as statistical data to support/enhance delivery of
GED Preparation Programs.
Learner’s Signature : ____________________________________
Date:_________________________
DEPARTMENTAL USE ONLY
Receipt Number:____________________________________
Date Notified: ________________________
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