Adult Literacy Program Inquiry Form
Please complete this form to be contacted about tuition free classes  to prepare for your High School Equivalency Diploma, improve your English language skills or to take classes to prepare for the US Citizenship Exam. All students must come to meet with us in-person to register and  take a placement test. We are admitting students year round and look forward to serving you!
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Email *
After completing this form, you will contacted by us to complete your registration in person,
Last Name *
First Name *
Date of Birth- list as Month/Day/Year *
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DD
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YYYY
Street Address 1 *
Street Address 2
City (must live in New York State) *
Zip Code *
Email address *
Phone Number (include area code) *
Please select course(s) you are interested in: *
Required
Days/ Times: Are you interested/available in classes offered days, evenings, weekends? Select as many as you like (please note that not all locations have availability for these times, we will contact you with current course schedules/locations):
Locations: Where do you prefer to take classes?  (please note that not all locations have availability for all courses, we will contact you with current course schedules/locations)
Why are interested in our classes?
Is there a class that we don’t have that you would like us to offer?
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