Logo for: Shoreline Adult Education
Go Further With Lifelong Learning

Adult Education Intake Form

Please complete the following form: *

Select course you want to take: *

Personal Info:

Gender: *
Ethnicity: (must select one) *

Race: (check all that apply) *

Public Assistance:    

Parent/Guardian of (check all that apply) *

Do you have your children in the Public School system? *  
If yes, which school/s and grade/s?


How many years did you attend school? *
Where was this highest educational level/degree attained? *
Last High School Attended (name and location if in the USA):

Barriers to Employment: (check all that apply) *

Miscellaneous Characteristics (check all that apply) *

Reasons for Enrollment (check all that apply)



Education *

Required Instruction

The Shoreline Adult Education program serves the communities of Branford, North Branford, Guilford and Clinton. The state-mandated High School Diploma/GED®, English for Speakers of Other Languages (ESOL), and Citizenship classes are FREE to those that live in thesecommunities.

Typing my name on this registration form affirms that I understand student information is confidential and will only be used for program administration, research and evaluation purposes. *