NCCVT Adult Education Registration Form (Waitlist as we are currently not entering students for the 2020/2021 school year)
This is our program's registration form both for Adult Basic Education and Groves Adult High School Classes*.

All information should be yours, as the student registering for the program. If you have any questions regarding this registration form, please contact our main office at (302) 683-3641 and leave a direct number we can call you back on since the building is still closed at this point. Also, we will need to contact you to get your Social Security number for reporting for the State of Delaware.

Note: Delaware Adult Education programs comply with the Americans with Disabilities Act of 2010. If you need a special accommodation, please notify your center.

*There is a $25 materials fee for each Groves Adult High School Semester. Adult Basic Education classes are free.
Email *
Which program are you interested in? *
Last Name *
First Name *
Middle Initial *
Address example: 1703 School Lane, Wilmington, DE 19808 *
Email Address *
Date of Birth (01/01/2001) *
Gender *
Home Phone Number (ex. 123-456-7890) *
Cell Phone (ex. 123-456-7890) *
Emergency Phone Number (ex. 123-456-7890) *
Emergency contact Name *
Name of Employer *
Employer Phone Number (ex. 123-456-7890) *
Are you an English as a Second Language Learner? *
Location of Last School Completed *
Last Grade Level or Degree Completed *
Ethnicity *
Race (Check all that apply) *
Work Status *
Barriers to Employment (check ALL that apply) *
Family Income (check one) *
Federal or State Assistance (Check all that apply) *
Internet Access (check all devices available for your use to access the Internet) *
Last Date Attended School (Year) *
Name of Last School Attended *
Have you taken any tests of the GED Exam? *
Year High School Diploma or GED was issued *
Previously enrolled in Adult Education or James H. Groves Classes? *
If yes, where? *
Referred by (Check all that apply) *
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