[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-265398-105":59,"doc-detail-265398-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","26-27-leis-form-printable-version","26-27-LEIS-Form-PRINTABLE-VERSION","","North Carolina Community College System Literacy Education Information System (LEIS) provider form for faculty/staff use, designed to capture student enrollment and demographic details. It records provider identifiers, program year, participation period, student bio information, race and ethnicity, birth date, gender, mailing address, enrollment and registration dates, program types, and primary contact information. The form also collects social security/identification fields, education and employment status, disabilities and special program eligibility, and related administrative data for NRS assessment placement.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/26-27-leis-form-printable-version/265398/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/26-27-leis-form-printable-version/265398.png","ImageObject",300,407,{"name":92,"@type":93},"Chumphorn","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-14",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What information does the LEIS form collect for providers?","Question",{"text":113,"@type":114},"The form captures provider name, ADVANSYS ID, program year, and the period of participation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which student demographic fields are included?",{"text":118,"@type":114},"It includes student bio (first/middle/last name and preferred name), race and ethnicity selection, date of birth, gender/sex, mailing address, and enrollment date.",{"name":120,"@type":111,"acceptedAnswer":121},"How does the form support NRS assessment placement?",{"text":122,"@type":114},"The form records NRS registration requirements and the student contact type (ESL or ABE/ASE), which determines the approved assessments and establishes a baseline for educational functioning level and placement on federal tables.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},265398,1789395257,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":144,"preview_page_count":4},2336475401981,"https://ap-avatar.wpscdn.com/avatar/22000c94efd8d5204d?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786935347598174694","| North Carolina Community College System  \u003Cbr>Literacy Education Information System (LEIS)(OFFICE USE ONLY:To be completed by faculty/staff)   |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Provider  \u003Cbr>Name:   |  | ADVANSYS ID:   |  | Program Year   |  |  |  |  |  |  |\n| Enrollment  \u003Cbr>Date:   |  | Colleague ID:   |  | Period of  \u003Cbr>Participation   | 1st   |  | 2nd   |  | 3rd   |  |\n\n\n| 9.Race   |  |\n| --- | --- |\n|  | American Indian or  \u003Cbr>Alaskan Native   |\n|  | Asian   |\n|  | Black or African  \u003Cbr>American   |\n|  | Native Hawaiian or  \u003Cbr>Other Pacific  \u003Cbr>Islander   |\n|  | White   |\n|  | More than One  \u003Cbr>Race   |\n\n\n| 7.Social Security  \u003Cbr>Number   |  |\n| --- | --- |\n|  |  |\n| Format:000-00-0000   |  |\n| EIN:   |  |\n| ITIN:   |  |\n\n\n| 1.Student Bio   |  |\n| --- | --- |\n| First Name:   |  |\n| Middle Name:   |  |\n| Last Name:   |  |\n| Preferred Name:   |  |\n| Maiden/Previous  \u003Cbr>Last Name(s):   |  |\n\n\n| 8.Ethnicity (Select one)   |  |\n| --- | --- |\n|  | Hispanic/Latino   |\n|  | Non-  \u003Cbr>Hispanic/Latino   |\n\n\n| 2.Date of Birth:(MM/DD/YYYY)   |  |  | 3.Gender/Sex   |  |\n| --- | --- | --- | --- | --- |\n|  |  |  |  | Female   |\n| Student is under 18.  \u003Cbr>Release form required.   |  |  |  |  |\n|  |  |  |  | Male   |\n\n\n| 4.Mailing Address   |  |\n| --- | --- |\n| Address Line 1   |  |\n| Address Line 2   |  |\n| City   |  |\n| State(postal  \u003Cbr>abbreviation)   |  |\n| Zip Code   |  |\n| County   |  |\n\n\n| 10.Enrollment Date:  \u003Cbr>(MM/DD/YYYY)   |  |\n| --- | --- |\n\n\n| 11.Program Type(s)  \u003Cbr>(NRS Registration Required):   |  |\n| --- | --- |\n|  | Adult High School Student(AHS)   |\n|  | Co-Enrollment in College Program   |\n|  | Integrated Education and Training Program(IET)   |\n|  | Integrated English Literacy &Civics Education  \u003Cbr>(IELCE)   |\n|  | Multiple Pathways to High School Equivalency  \u003Cbr>(MPHSE)   |\n|  | NRS Registration(ABE/ASE or ESL)   |\n|  | Work-Based Learning Program   |\n\n\n| 5.Primary Contact Phone Numbers   |  |\n| --- | --- |\n| Phone\\#:   |  |\n| Emergency \\#:   |  |\n| Work\\#:   |  |\n| Cell\\#:   |  |\n\n\n| 6.Email (Enter Below)   |\n| --- |\n|  |\n\n  l  . .  \n\n| 19.Special Programs  \u003Cbr>(Check yes or no for allfields)   |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Basic Skills Plus   |  | Yes   |  | No   |\n| In Correctional Facility   |  | Yes   |  | No   |\n| In Community  \u003Cbr>Correctional Program   |  | Yes   |  | No   |\n| In Other Institutional  \u003Cbr>Setting   |  | Yes   |  | No   |\n\n\n| 12.Registration Date:  \u003Cbr>(MM/DD/YYYY):   |  |\n| --- | --- |\n\n\n| 13.Name of Last  \u003Cbr>Secondary/Elementary  \u003Cbr>School attended:   |  |\n| --- | --- |\n| 14.Last Date Attended  \u003Cbr>(MM/DD/YYYY):   |  |\n| 5.Country of Last  \u003Cbr>School Attended:   |  |\n\n\n| 20.Student Data(check yes or no for all fields)   |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Displaced Homemaker   |  | Yes   |  | No   |\n| Long-term Unemployed   |  | Yes   |  | No   |\n| Cultural Barrier   |  | Yes   |  | No   |\n| Low Income   |  | Yes   |  | No   |\n| Ex-offender   |  | Yes   |  | No   |\n\n\n| 16.Educational Level atentry  \u003Cbr>(check one and enter grade level if applicable)   |  |\n| --- | --- |\n|  | No Schooling   |\n|  | No diploma(Enter 1-11 for last grade  \u003Cbr>completed instead of a check)   |\n|  | High school graduate/Grade 12 completed   |\n|  | High School Equivalency graduate   |\n|  | Adult High School graduate   |\n|  | Certificate of attendance/completion asa  \u003Cbr>result of completing an IEP   |\n|  | Some Postsecondary education,no degree   |\n|  | Post high school vocational diploma   |\n|  | Associate degree   |\n|  | Bachelor degree   |\n|  | Master degree or higher   |\n|  | Unknown   |\n\n\n| Inmate Type:   |  |\n| --- | --- |\n| Inmate  \u003Cbr>Release Date:   |  |\n\n\n| DMV status:Complete if you are an NCresident  \u003Cbr>under age 18(Community College attendee only)   |  |\n| --- | --- |\n| Driver's License\\#:   |  |\n| Issue Date  \u003Cbr>(MM/DD/YYYY):   |  |\n| State Issued:   |  |\n\n\n|  | No license,but plan to get on","cbCainyEP6CtjQXn","https://ap.wps.com/l/cbCainyEP6CtjQXn","pdf",575260,"English","# Provider Information\n# Student Demographics\n## Race and Ethnicity\n## Birth, Gender, and Address\n# Enrollment and Program Details\n## Program Type(s) and Dates\n## NRS Registration and Contact Type\n# Employment, Education Level, and Special Programs\n## Employment Status\n## Educational Level at Entry\n## Special Programs and Disabilities","[{\"question\":\"What information does the LEIS form collect for providers?\",\"answer\":\"The form captures provider name, ADVANSYS ID, program year, and the period of participation.\"},{\"question\":\"Which student demographic fields are included?\",\"answer\":\"It includes student bio (first/middle/last name and preferred name), race and ethnicity selection, date of birth, gender/sex, mailing address, and enrollment date.\"},{\"question\":\"How does the form support NRS assessment placement?\",\"answer\":\"The form records NRS registration requirements and the student contact type (ESL or ABE/ASE), which determines the approved assessments and establishes a baseline for educational functioning level and placement on federal tables.\"}]","26-27-LEIS-Form-PRINTABLE-VERSION | PDF",13]