New Bedford Clemente Course in the Humanities
Why do you want to take the Clemente Course? *
Your answer
First name *
Your answer
Last name *
Your answer
Age *
Your answer
Address *
Your answer
Address, continued
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email address *
Your answer
Phone number *
Your answer
Years of education *
How did you find out about Clemente? *
Your answer
Total monthly household income (approximately) *
Your answer
Total number of people in your household? *
Your answer
Will you need transportation (taxi) to and from class, on Monday/Thursday 6pm to 8pm? *
Will you need childcare during class time? *
Name and age of child requiring childcare
Your answer
Name and age of child requiring childcare
Your answer
Name and age of child requiring childcare
Your answer
Name and age of child requiring childcare
Your answer
Name and age of child requiring childcare
Your answer
Please type your response to the John Lewis reading, below. What did you think of the article? What do you think the author was trying to say? You can find the reading here: https://www.mlkjrfamilyservices.org/uploads/4/8/6/2/48627309/clemente_reading.pdf *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service