The Mississippi Community College Board Office of Adult Education Intake Assessment Form is required for all adult learners in all programs. Pages 1 and 2 of the form need to be completed entirely. Only signatures are required for page 3.

Please print and complete the PDF form below and return to the East Central Community College Office of Adult Education, P.O. Box 129, Decatur, MS 39327, or to the offices located in Etheridge Hall on the main campus in Decatur. For more information, please call 601-635-6278.

Intake Assessment Form