Logo for: Shoreline Adult Education
Go Further With Lifelong Learning

Student Registration Form

English Español

Please complete the following form: *

Select course you want to take: *

Personal Info:
Gender: *
Ethnicity: (must select one) *
Race: (check all that apply) *



Education:

Highest Education Level Completed on Entry: *Please write in the grade level
Where was this highest educational level/degree attained? *
Last High School Attended (name and location if in the USA):

Employment

Miscellaneous Characteristics (check all that apply)

Which of the following do you have at home so we can contact you and/or connect you to services? (check all that apply) *
If yes, please complete below:

WIOA Core Programs Co-Enrollment: (check all that apply) *

If yes, Start Date:

All students must check one category below:

Low literacy levels *
 English Language Learner *

check all that apply:

Cultural barriers *
 Disabled *
Displaced Homemaker *
 Low income/Public Assistance *
Ex Offender *
 No TANF within 2 years or less *
Foster Care Youth *
 Homeless/Runaway Youth *
Long-term Unemployed *
 Migrant or seasonal farmworker (if yes, select a subcategory) *
Dislocated Worker *


Single Parent/Guardian (or single pregnant woman)

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 these communities.

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. *