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.
* Required
Email
*
Your email
Which program are you interested in?
*
High School Diploma
GED
Skill Building - you already have your HS diploma or GED
English as a Second Language Classes
Construction Trade for English as a second Language Learners ONLY
CNA (Certified Nursing Assistant) for English as a second Language Learners ONLY
Other:
Last Name
*
Your answer
First Name
*
Your answer
Middle Initial
*
Your answer
Address example: 1703 School Lane, Wilmington, DE 19808
*
Your answer
Email Address
*
Your answer
Date of Birth (01/01/2001)
*
Your answer
Gender
*
Female
Male
Home Phone Number (ex. 123-456-7890)
*
Your answer
Cell Phone (ex. 123-456-7890)
*
Your answer
Emergency Phone Number (ex. 123-456-7890)
*
Your answer
Emergency contact Name
*
Your answer
Name of Employer
*
Your answer
Employer Phone Number (ex. 123-456-7890)
*
Your answer
Are you an English as a Second Language Learner?
*
Yes
No
Location of Last School Completed
*
U.S. Based
Non-U.S. Based
Last Grade Level or Degree Completed
*
No Schooling
Grades 1-5
Grades 6-8
No Diploma Grades 9-12
H.S. Diploma
GED
Some College, No Degree
College or Professional Degree
Ethnicity
*
Hispanic or Latino
Not Hispanic or Latino
Race (Check all that apply)
*
American Indian or Alaska Native
Black or African American
Asian
Native Hawaiian or Pacific Islander
White
Required
Work Status
*
Employed Full Time
Employed Part Time
Employed, but received Notice of Termination or Military Separation is pending
Unemployed (available and actively seeking a job)
Not in Labor Force (not employed and not seeking a job)
Barriers to Employment (check ALL that apply)
*
Low Literacy Levels
English Language Learner
Cultural Barriers
Disabled
Displaced Homemaker
Low-Income Individual
Ex-Offender
Exhausting TANF within Two Years
Foster Child
Homeless
Long Term Unemployment
Migrant and/or seasonal Farmworker
Single Parent/Guardian
Required
Family Income (check one)
*
$0-10,830
$10,831-14,570
$14,571-18,310
$18,311-22,050
$22,051-25,790
$25,791-29,530
$29,531-33,270
$33,271-37,010
$37,011-40,000
>$40,001
Federal or State Assistance (Check all that apply)
*
Assistance for food
Medicaid
SSI
Unemployment Insurance
WIC
Required
Internet Access (check all devices available for your use to access the Internet)
*
Computer (Laptop or desktop)
Android Phone
Iphone
Android Tablet
Ipad
Chrome Book
Other Devices
Required
Last Date Attended School (Year)
*
Your answer
Name of Last School Attended
*
Your answer
Have you taken any tests of the GED Exam?
*
Yes
No
Year High School Diploma or GED was issued
*
Your answer
Previously enrolled in Adult Education or James H. Groves Classes?
*
yes
No
If yes, where?
*
Your answer
Referred by (Check all that apply)
*
Friend
Family
Social Media
Advertisement
Agency/Social Services
Other
Required
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