Nashua ALC Registration Form - MATH090 (2025-2026)

Nashua ALC Registration Form - MATH090 (2025-2026)

Please complete all information and click SUBMIT at the bottom of the page. The Counselor will contact you within 1 week after you submit the form to complete the registration process. Students are required to live or work in New Hampshire to qualify for class. Additionally, students must take the TABE (Test of Adult Basic Education) Math test prior to beginning the class and at the end of the class before taking the Accuplacer. If you have questions or need assistance completing this form, contact the Adult Education Counselor, Bill Bissonnette, at 603-288-7526 or email bbissonnette@nashuaalc.org.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Can we text you at this number?*

YesNo
What is the best way to contact you?*

TextCallEmail
Emergency Contact: Who can we call for you in case of emergency?
Name, Phone Number
Birthdate*

MonthDayYear
Date
Gender*
What country were you born in?*
What is your first language?*
Are you Hispanic or Latino?*

YesNo
What is your race or ethnicity? (Check all that apply.)*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite
How many years did you go to school?*
Where did you complete your schooling?*

In the USOutside of the US
Do you have a high school diploma?*

YesNo
If yes, what is the name of your high school?
Do you have a university or college degree or specialized training certificate?*

YesNo
If yes, what is the name of the school?
What is the highest degree earned?

Assoc.BachelorMastersDoctorate
What was your course of study?
What professional certificates, licenses or credentials have you earned?
Are you currently enrolled in or attending a different school (high school or other)?*

YesNo
If yes, what is the name of the school?
Are you currently enrolled in a college/training program?*

YesNo
If yes, what is the name of the school?
If yes, what class/course are you taking?
Are you currently employed?*

Yes - Full timeYes - Part timeNo
Are you looking for work?*

Yes, I am looking for work.No, I am not looking for work.No, I am retired.
If you are working, what is the name of the company or industry?
What is your job title?
How many hours (about) do you work per week?
Do you have any barriers to employment? (Check all that apply.)*

Cultural barriersDisabilityDisplaced homemakerLow incomeEx-offenderExhausting TANF within 2 yearsHomelessLong term unemployedMigrant farm workerSeasonal farm workerSingle parent or guardianNone
Are you currently working with any of the following Employment Security programs? (Check all that apply)

Wagner-PeyserTrade Adjustment AssistanceJobs for VeteransUnemployment InsuranceTANF/NHEP
Are you currently working with any of the following Office of Workforce Opportunity programs?

WIOA AdultWIOA Youth/NH JAG/My TurnDislocated Worker (Title I)SCSEP/National Able
Are you currently working with any of the following Department of Education programs?

Voc RehabCareer and Tech. Ed. (CTE)Community College Systems of NH (WorkReady NH, ApprenticeshipNh, Certificate and degree program at the Community Colleges)Adult Education other than this center - please type name of program below:Other
Are you currently working with any of the following programs?

SNAP Employment & TrainingHUD Employment & Training
Which class do you want to attend?*

Monday and Wednesday, 6:00-8:00pmTuesday and Thursday, 8:00-10:00am
How comfortable do you feel using technology?*
Which of the following do you have at home? (Check all that apply)

Computer with CameraComputer without CameraWebcamHeadset with microphoneMobile PhoneHome PhoneInternet AccessPrinterScannerNone
Attendance policy: after 3 unexcused absences you will be removed from class and be asked to attend the next open session. Please initial that you have read and understand this policy.*
Is there anyone (parent, child, case worker, etc.) you give us permission to talk to about your education? (If yes, please list.)
Is there anything else we should know about you? (For example: medical issues, learning difficulties, classroom comfort needs, etc.) This question is optional.
Where did you hear about us? Check all that apply.*

Nashua Adult Learning Center WebsiteFacebookFlyerFriend or familyEmployer or coworkerNashua Public LibraryCommunity CollegeOther adult learning centerNH adult ed websiteEventWalking byOther
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