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Summer 2020 Registration Reservation Form
Please complete this form in its entirety to reserve your registration seat for the Summer 2020 term.
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* Indicates required question
Which program are you interested in attending?
*
James H. Groves High School Diploma Program
Adult Basic Education/GED
Required
Have you previously attended a program at the Delaware Center for Distance Adult Learning, Inc.?
*
Yes
No
Please select from the list below any other adult education sites in Delaware that you attended.
*
Christina
Del Tech- Owens Campus
Latin American Community Center
New Castle County Vo-Tech
Polytech
Sussex Tech
Appoquinimink
Del Tech- George Campus
Del Tech- Terry Campus
Red Clay
West End
None
Required
First Name
*
Your answer
Middle Name (If applicable)
Your answer
Last Name
*
Your answer
Maiden Name (If applicable)
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Last Four (4) Numbers of Social Security Number
*
Your answer
Home Telephone Number
*
Your answer
Cell Phone Number
*
Your answer
Email address
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
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