When form is completed please call cont ed office to schedule your placement test at (203)-385-4270 OR email continuingeducation@stratk12.org. Testing and classes take place at 468 Birdseye Street, Stratford CT 06615.

Stratford/ Trumbull Continuing Education Registration Form

PROGRAM: *
Are you a new student? *
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Are you a resident of Stratford or Trumbull? *

Student Information

Gender: *
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Emergency Contact

Ethnicity

Ethnicity *
RACE (Must check one or more) *

Education Background

Highest Ed Level Location: *

Employment Status

Your Status of Employment *

Miscellaneous

Characteristics (check all that apply) *
You are a Parent/Guardian of: *
Child(ren) 5 Years & YoungerChild(ren) 6 -10 YearsChild(ren) 11- 18 Years
Select the number of children under your care according to age bracket. Must select for each drop down.

Check all that apply

Do you feel your culture, beliefs, or practices makes finding/keeping a job harder? *
Are you an English language learner? *
Are you a low level literacy learner? *
Do you have a criminal record that makes it hard for you to find a job? *
Are/were you in the foster care system and are under 24 years old? *
Are you homeless? Do you live in a motel, hotel, campground, transitional housing or with another person because you lost your apartment? *
Have you been unemployed for 27 or more weeks (more than 6 months)? *
Are you a migrant and seasonal farmworker *
Are you a single parent, unmarried or separated and have primary responsibility for one or more children under the age of 18, or are you a single, pregnant woman? *
Do you have a low income? Do you receive SNAP, TANF, SSI, or local public assistance? *
Are you a former homemaker who is having trouble finding a job or a better job? *
Have you been fired or laid off? Are you unemployed because the place where you work has closed? *
Do you wish to disclose any disability that limits your life activities? *

File Upload (If you are unable to upload documents please bring them in at time of placement test)




Completion

I understand that student information is confidential and will only be used for program administration, research and evaluation purposes. PLEASE SIGN USING TOUCH PAD OR MOUSE *
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Handbook Sign-Off Sheet/Internet/Telecommunications Acceptable Use Policy

Click the link below to read the student handbook:
 
Student Handbook
PLEASE SIGN USING TOUCH PAD OR MOUSE *
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When form is completed please call cont ed office to schedule your placement test at (203)-385-4270 OR email continuingeducation@stratk12.org. Testing and classes take place at 468 Birdseye Street, Stratford CT 06615.