Request edit access
ERACE ESL INTAKE SURVEY
Name *
Your answer
Address (Street name and number) *
Your answer
Address (Town and zip) *
Your answer
Email address *
Your answer
Cell Phone Number: *
Your answer
Program of Interest: *
How did you find out about our ERACE ESL classes? *
Required
Do you have access to a computer at home?
Will you use our open computer lab? (available Monday and Wednesday 6:15-8:15)
If pictures are taken, do we have your permission to use them in our marketing? *
Required
APPROVAL (this electronic signature will serve as my approval) please type your full name: *
Your answer
Can we email you about upcoming ERACE ACLC events? *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Branford Public Schools. Report Abuse - Terms of Service