East Hartford Adult Education 2020/2021 Registration Form
Please complete all required questions and click "submit" when done. You will be contacted via email regarding class availability, pre-testing, and any other required documents we may need.
Please note that the majority of our classes are closed to new registrations.
We will be offering a limited number of classes over the summer, and a full schedule in the fall. Please check our website (
) or follow us on Facebook (East Hartford Adult Education) for more updates.
I am currently enrolled in:
I am not a current student
GED - morning session (9:00 am)
GED - afternoon session (12:00 pm)
GED - evening session (6:00 pm)
GED in Spanish (6:00 pm)
ESL - morning session (9:00 am)
ESL - mid-day session (11:00 am)
ESL - afternoon session (1:15 pm)
ESL - evening Session (6:00 pm)
Citizenship (6:00 pm)
Family Literacy (3:30 pm)
I was waitlisted for the Fall 2020 semester
Social Security Number
I am enrolling in the following program(s) for Spring 2021:
**WAITLIST ONLY** NEDP, flexible dates and times, virtual **WAITLIST ONLY**
CDP, flexible dates and times, virtual **This program is unavailable until the Fall. Please still choose this option, if it is right for you. And, please get a copy of your high school transcripts to us.
Family Literacy, 3:30 pm - 5:30 pm, Wednesday, in-person, ECLC @ Hockanum School
Date of Birth
Are you Hispanic/Latino?
What is your race? Check all that apply
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Other Pacific Islander
What is the highest level of education you completed?
12th Grade - No Diploma
Graduated High School
Some College or Postsecondary Education - No Degree
Postsecondary or Professional Degree
Was your highest level of education completed in the United States?
What was the name of the last high school you attended?
What is your employment status?
Not looking for work
Unavailable for work
Unemployed with separation notice
Do you have any barriers to employment? Select all that apply
No barriers to employment
Cultural Barriers (does your attitude, belief, customs or practices serve as a hindrance to employment?)
Disabled (do you wish to disclose any disability that limits your life activities?)
Displaced Homemaker (did you provide unpaid services to family members in the home and were dependent on the income of another family member, but are no longer supported by that income?)
English Language Learner (do you have limited ability in speaking, readint, writing, or understanding the English language?)
Ex Offender (were you, or are you, in any stage of the criminal justice process for committing a status offense or delinquent act? Or, do you require assistance in overcoming artificial barriers to employment resulting from a record of arrest or conviction?)
Exhausting TANF Within Two Years (are you within two years of exhausting lifetime eligibility under Part A of Title IV of the Social Security Act?)
Foster Care Youth (are you currently in, or aged out of, the foster care system?)
Long Term Unemployed (have you been unemployed for 27 or more weeks?)
Low Literacy Levels (are you unable to read, write, and speak in English?)
Single Parent or Guardian
City, State, Zip Code
Home Phone Number (enter "none" if you do not have a home phone)
Mobile/Cell Phone Number (enter "none" if you do not have a mobile/cell phone)
Work Phone Number (enter "none" if you do not have a work phone number)
Check all that apply:
I receive public assisstance
I am a dislocated worker
I am a minor with adult status
I am an imigrant
I am incarcerated at a state prison
I am incarcerated at a community jail
I have an apparent or disclosed disability
I have an observed/disclosed learning disability
I have a documented learning disability
None of the above
Miscellaneous Characteristics (check all that apply):
Receive Public Assistance
Mother Under 17 - C.G.S.10-73d
Needs Child/Dependent Care
None of the above
Of how many children ages 5 years and younger are you the parent/guardian? If none, please enter "none"
Of how many children ages 6 to 10 years and younger are you the parent/guardian? If none, please enter "none"
Of how many children ages 11 to 18 years and younger are you the parent/guardian? If none, please enter "none"
Name of emergency contact:
Never submit passwords through Google Forms.
This form was created inside of East Hartford Public Schools.