STUDENT REGISTRATION - SUMMER 2022
Our summer session runs from May 31 until July 16.
Please answer the following questions to enter our online and in-person Summer 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. info@lincolnliteracy.org

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First Name: *
Middle Name (or Initial):
Last Name (or Family Name): *
Street Address (you must live in Lincoln, NE, or within 40 miles): *
City *
State: *
Zip Code: *
Cell Phone Number? *
Other Phone?
Email:
Please type your date of birth *
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Gender *
Country of Origin: *
What languages do you speak? *
Can you read and write in your first language? *
Are you a refugee, asylee or SIV?  (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, Asylees or SIV need to answer here. Immigrants may answer, too.
MM
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DD
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YYYY
Do you have a job now? *
How do you identify by race or ethnicity? *
Check one or more boxes to describe yourself.
Required
Select your highest level of education, including education outside the U.S:
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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? *
Do you have any children age 12 or younger? *
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