Darlington County Adult Education Student Referral Form

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Referral Guidelines

Requirements in Detail	1. To refer a potential student to Darlington County Adult Education, please complete this form and return it to the Adult Education Office. For students seeking the traditional high school diploma, please also include a copy of the student’s official high school transcript. 2. As an incentive, students referred from First Steps will not have to wait until the next scheduled registration time. Referred students will be accepted by appointment in the order in which the referrals are received. 3. Students referred from First Steps may qualify for all testing and associated fees to be provided at no cost. This may also include study materials and, in some cases, transportation. 4. Please submit completed referral forms to: Darlington County Adult Education 100 Magnolia St. Darlington, SC 29532 or Fax: 843-395-8944.

Referring Program Information

	Program Name: Darlington County First Steps
Contact Name	Required*
Email	Required*
Date	//
Phone	Required* --
Fax	--

Student Information

Full Name

First Name

Last Name

Address

Street 1

Street 2

City

State

Zip

Home Phone

Mobile Phone

E-mail Address

Program

Site

For DCAE Office Use Only

Date Received
Assigned To
Received By
Site	Darlington, Hartsville, Society Hill, Lamar