English Language Learning Class Registration
Welcome!  This form will give us the information we need to register you in our English Language Learning classes.  If you have translated this form into a language other than English, you might have to return to the English form to answer the questions.  Thank you!
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Our next classes start August 8, 2022.  When are you available to take a pre-test? *
Some of our  English Language Learning classes are taught online.  Here is a list of what you will need.  Please check the items you have:
When a teacher meets with you the first time:
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Social Security Number
Last Name *
First Name *
Middle Initial
Street Address *
City *
State *
Zip Code *
Primary Phone Number (XXX-XXX-XXXX)
Emergency Phone Number (XXX-XXX-XXXX)
Cell Phone Number (XXX-XXX-XXXX)
Prefer Text Message?
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E-mail Address *
Date of Birth (Month, Day, Year) *
Age *
Gender *
Maiden Name
Ethnicity *
Race (If Ethnicity is "Other", choose one of these
Native Country (leave blank if USA)
U. S. Citizen?  (We gladly serve everyone.) *
Have you attended MCCSC Adult Education classes before? *
Medical concerns we should be aware of:
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