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

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.