Adult Education Student Registration

Please complete the following form: *


Select course you want to take: *



Personal Info:

Gender: *
Secondary ID Type:








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?

Education:

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)

Community

Employment


Education *



Required Instruction
Family







For students registering for high school diploma /GED please upload a picture of a valid CT Driver's License, State ID, Passport or other photo identification card.

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.

*

Shoreline Adult Education 185 East Main Street
Branford, CT 06405

203.488.5693
Fax: 203.315.5149

Towns Served: Branford, Clinton,
Guilford, North Branford