New London Adult & Continuing Education

Applicant Enrollment Information


Please complete the following form: *

Select course you want to take: *

What Location will you be attending: *

Fall 2020: *

Personal Info:

Gender: *
Ethnicity: *
Race: (Check all that apply)

Public Assistance:

Rural/Urban Status:

Permission to publish your photo? *


Employment Status: *

Parent/Guardian of (select all that apply) *


Highest Educational Level/Degree Completed at Entry: *
Where was the highest educational level/degree attained? *
Last High School attended and address:

Miscellaneous (select all that apply) *

Disability: *


Employment Barriers:

Reasons for Enrollment:

Employment *

Required Instruction
Education *

Family and Community

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.