Meriden Adult, Continuing & Career Education

Online Registration

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Please complete the following form: *


Select course you want to take: *


Which semester and time will you be attending: *


Personal Info:

Marital Status: *
Gender: *
Birthplace:
Ethnicity: *
Race: * (Check all that apply)



Contact Person's Relationship: *

Employment:

Employment Status: *






Parent/Guardian of (select all that apply) *


Education: *

Highest Educational Level/Degree Completed at Entry (Write in the grade level):
Last school attended and address:
 

Disability: *





Military Service Experience: *


Employment Barriers: * (select all that apply)


Educational goals/reasons for enrollment: * (select all that apply)









Family and Community: * (select all that apply)








Please upload the mandatory documents below.  If documents are not available at this time, you may upload them at a later time using the form found here.  Documents must be received before the registration period ends on February 4, 2022.

Upload Photo ID:


Upload Proof of Residency:


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.