• Student Registration

  •  -
  • Type of Phone Number*
  • What is the best way to contact you?*

  • Tell us about yourself

  • Gender*
  • Birthdate*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are you Hispanic/Latino?*
  • What is your race? Choose all that apply.*

  • Emergency Contact

    Who should we contact in case of emergency?
  •  -

  • Education Questions

  • Are you currently enrolled in or attending a different school (high school or other)?*
  • Have you studied here before?*
  • Have you studied at a different adult learning center?*
  • What programs or services are you interested in at Dover Adult Learning Center? (What do you hope to do here?)*
  • I would like to ...*
  • How will you get to school?*
  • I would like to attend class in the...*
  • Which location do you prefer? *
  • I have the following types of technology at home that I can use for my learning at DALC - Check all that apply*

  • Employment Questions

  • Are you working?*
  • Are you currently working with any of these agencies? Check alI that apply. If no, check "none."*

  • Household Questions

    Thank you for taking the time to answer the following questions which help keep our programs free for students.
  • Are you married?*
  • Do you have children*
  • Do you need childcare to attend class?*

  • Other information

  • Are you currently in any of these categories? Check all that apply or check "none."*
  • How did you hear about Dover Adult Learning Center?*

  • Privacy Policy, Statement of Confidentiality, Internet and Computer Use, and Release of Information Forms

    All information will be treated as confidential and used only for educational purposes.

    Please read through the NH Works System Partners Release of Information form, Photo/Media Release information, Social Security number information, and Computer and Internet Use form.

  • I have read the release of information, and I agree to share information with NH WORKS System Partners.*
  • I grant permission to Dover Adult Learning Center to use photographs and/or video taken of me for marketing, campaign, fundraising, and other publicity purposes. I understand that this material may appear on posters, in marketing materials, campaign literature, video and other media releases including the Web. If I do not grant permission to use photos of me, it is my responsibility to inform the photographer and remove myself from the area being photographed or videotaped.*
  • The NH Department of Education would like your social security number for data matching for federal reporting and educational research. Will you share your social security number with a DALC staff member through phone or in person?*
  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: