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!
Our next classes will start on September 28, 2020. Which class are you interested in?
Clear selection
Our class this Fall might be taught online if we cannot meet in person. If class is online, here is a list of what you would need. Please check the items you have:
When a teacher meets with you the first time:
Clear selection
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?
Clear selection
E-mail Address
Date of Birth (Month, Day, Year)
Age
Gender
Clear selection
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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