Logo for: Windsor Adult Education

Student Registration Form

All student information is confidential and will only be used for program administration, research, and evaluation purposes. Please arrive at least 5-10 minutes before your scheduled test(s) appointments.

  • To provide proof of identity and residency, please bring a valid State of Connecticut photo identification (e.g. driver's license/permit). If your valid ID does not have your current Windsor address, please bring a piece of mail with your name and current address (e.g. utility bill) not older than 90 days.
  • Tuition is free for Windsor Residents. All others require a $10.00 in cash registration processing fee due on the day of placement testing.
  • Please note that for students aged 17 and 18 years, a completed official withdrawal form is required to be able to test and complete registration.
  • Contact the office at 860.687.2000 x1271 to reschedule if you are unable to make your test(s) appointment(s).
  • Please remember to make a note of your test date & time for future reference.

Please complete the following form: (* denotes required fields)

Student Type: *

Select Course You Want to Take: *

Personal Info:


Race: (Check all that apply) *

Emergency Contact Info: *

WIOA Core Programs: *


Do you receive individualized services through the AJC? Receive regular career counseling (group or individual) assigned worker appointments? Enrolled in training (for age 24+) paid for by the AJC?

Do you receive unemployment benefits? Identify as a dislocated worker or trying to return to work from previously working as a homemaker?

Are you currently an in-school or out-of-school youth who is out and receiving services from your local American Job Center (AJC)?

Are you currently registered with your local AJC? Do you currently utilize your local AJC for workshops and the self-serve computer access?

Are you currently working with the Bureau of Rehabilitation Services (BRS) to find employment? Do you have a disability that impacts your ability to obtain and maintain employment? Do you have an employment plan with the state vocational rehabilitation agency/BRS/BESB?

Education Information:
Highest Educational Level Location: *

Employment Information:

Employment Status:*

Barriers to Education: *

Cultural Barriers:
Do you feel your culture, beliefs, or practices makes finding/keeping a job harder?
  
Disabled:
Do you wish to disclose any disability that limits your life activities?
  
Displaced Homemaker:
Are you a former homemaker who is having trouble finding a job or a better job?
  
Low Income:
Do you have a low income?
  
English Language Learner:
Are you an English Language Learner?
  
Ex Offender:
Do you have a criminal record that makes it hard to find a job? (Do not select this category if you are currently incarcerated)
  
No TANF within 2 years or less:
Within two years, will you no longer be eligible to receive Temporary Assistance for Needy Families (TANF) benefits?
  
Youth in Foster Care:
Are/were you in the foster care system and are under 24 years old?
  
Homeless:
Are you homeless? Do you lack a regular and adequate residence? Do you live in a motel, hotel, campground, transitional housing or with another person because you lost your house or apartment?
  
Long-Term Unemployed:
Have you been unemployed for 27 or more weeks (more than 6 months)?
  
Low Literacy Levels:
(ABE, GED, NEDP, CDP students; all students who do not have a Secondary School Diploma at entry). Are your literacy levels low?
  
Migrant and Seasonal Farmworker:
(if yes, select a subcategory)
  
Are you a seasonal farmworker who has worked in the last 12 months in agriculture, fish or on a farm?
  
Are you a seasonal worker with no permanent residence?
  
Single Parent or Guardian:
Are you a single parent, unmarried or separated and have primary responsibility for one or more children under age 18?
  

Miscellaneous Characteristics

Why are you enrolling in Adult Education? *

Select all that apply to you:

Which of the following do you have at home? (Select all that apply)*

Family Information (select all that apply)*

Exam Dates & Times *

If you are registering for English as a Second Language (ESL) and/or Citizenship classes, you are required to take a reading test for proper class placement. This will take approximately one hour to complete.

If you are registering for High School Completion (GED®) or ABE classes, you are required to take a reading and math test for proper class placement. This will take approximately two hours to complete and can be done in one testing session or two.

Select date and time. If you prefer two sessions, please indicate.

Computer Acceptable Use Policy *

I agree to take personal responsibility for following the rules of the acceptable use policy stated in this contract. I will:

  1. Use the on-line resources provided by my school ONLY for school-sanctioned projects.
  2. Use the on-line resources provided by my school ONLY with the permission of a teacher or library media specialist.
  3. Use language on-line which is consistent with school policy.
  4. Not tamper with equipment or software; nor alter the network interface; nor attempt to gain access to the data and files of others; nor attempt to access information on the Internet, or other online services, not consistent with the educational goals of the school; nor violate any copyright laws.
  5. Report any problems or breaches of this agreement to a teacher.
  6. Not use the Internet inappropriately and understand that if I do, my behavior will result in:
    1. Losing all on-line privileges within the school setting.
    2. Being subjected to disciplinary measures under Windsor Adult Education Policy, Board of Education Policy, and/or being referred to the appropriate legal authorities, if warranted.


Electronic Signature *

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.

*

I understand that student information is confidential and will only be used for program administration, research and evaluation purposes.