Wayne Metro LEAPS Registration

Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

First Name

Last Name

Street Address

City

State

Zip Code

Phone Number

Email Address

Please select your gender identity.

Prefer to self-describe below.

Date of birth [Example: 01/01/2000]

Do you own or rent your home?

Are you currently employed?

Are you currently receiving unemployment?

Are you currently receiving SNAP benefits [food assistance]?

How many adults are in your household?

How many children in your household are ages 0-8?

How many children in your household are ages 9-17?

Do you have children enrolled in Wayne Metro Head Start?

YesNo

Which Head Start location?

If you have school-age children in your family, what is the name of the school(s) your children attend?

Annual Household Income

Which class would you like to register for? All classes are virtual.

Please describe your education background [include schools you've attended, grades you've completed, etc...]:

Please upload the following documents:

Photo ID

Birth Certificates of Children in the Household or other document verifying birth.

Proof of Income for the last 30 days

Proof of unemployment income

Proof of SNAP benefits

Additional documents [optional]

CONSENT: I/We hereby allow Wayne Metropolitan Community Action Agency, its agents, employees, sub-contractors or affiliates to communicate with and request information from all housing, utility and income providers listed on Wayne Metro's related forms and to enter my/our personal information into the applicable program databases. This release expires two (2) years from the date of application. I agree that photocopies of this authorization may be used for the purposes stated above.

As a service provider, Wayne Metro will NOT share your information with any organization or persons who are not mentioned on this application.

I Agree

If you have questions about GED, ESL or Adult Basic Education, please reach out to Deanne Surles at dsurles@waynemetro.org.

Press Submit below to complete your registration form.

Save my progress and resume later | Resume a previously saved form

Contact Information