Our fall session runs from August 29th until December 17th. We will offer more than 100 classes!
Please answer the following questions to enter our online and in-person Fall 2022 classes.

Covid vaccinations and boosters are recommended. Masking is also recommended. These guidelines may change if community conditions worsen due to another Covid outbreak.

Your personal information will not be shared without your permission.
After you submit the form, someone from Lincoln Literacy will contact you about classes.

Need help?  Cần giúp đỡ    ¿Necesita ayuda?  تە هاری کاری ڤئت  Потрібна допомога?   需要帮助吗?  
Besoin d'assistance?  Нужна помощь?    هل تحتاج مساعدة؟  
☎  402-476-7323  📲  402-475-3774.
Sign in to Google to save your progress. Learn more
First Name: *
Last Name (or Family Name): *
Street Address (you must live in Lincoln, NE, or within 40 miles): *
City *
State: *
Zip Code: *
Phone Number? *
Other Phone?
Date Of Birth *
Gender *
Country of Origin: *
What languages do you speak? Write your primary language first. *
Can you read and write in your first language? *
Can you read and write in English?
Clear selection
Are you a refugee, parolee or asylee?  (If you are, you may be able to get priority for van service and childcare, but will need to provide copy of I-94 or green card.) *
When did you arrive in the USA?
Only Refugees, parolees or asylees need to answer here. Immigrants may answer, too. Homegrown Americans do not need to answer.
Do you have a job now? *
How do you identify by race or ethnicity? *
Check one or more boxes to describe yourself.
Select your highest level of education, including education outside the U.S:
Clear selection
What is your total family income each month before taxes: *
This information is used only for statistical  purposes only. Personal information will not be shared.
How many people live in your house or apartment? *
Sometimes we take pictures in class. Is it okay if we use your picture for newsletters, social media, etc.?
Clear selection
Do you have any children age 12 or younger? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Lincoln Literacy Council. Report Abuse