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 (www.adulted.easthartford.org) or follow us on Facebook (East Hartford Adult Education) for more updates.
First Name *
Last Name *
Middle Name
I am currently enrolled in: *
Social Security Number *
I am enrolling in the following program(s): *
Required
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Are you Hispanic/Latino? *
What is your race? Check all that apply *
Required
What is the highest level of education you completed? *
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? *
Do you have any barriers to employment? Select all that apply *
Required
Street Address *
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) *
Email Address *
Check all that apply: *
Required
Miscellaneous Characteristics (check all that apply): *
Required
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: *
Emergency telephone: *
Submit
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