2024 Microsoft Office Registration
Please note: The CA Department of Education requests demographic data for all adults who enroll in classes. This information may assist our school in qualifying for State and Federal Funds. Information is confidential and only reported collectively.
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Name / Nombre: *
Address / Direccion: *
City, State, Zip/Ciudad, Estado, Codigo Postal *
Birth Date / Fecha de Nacimiento: *
Social Security Number (Optional) / Numero de Seguro Social (Opcional)
Gender / Genero *
Home phone / Telefono de Casa: *
Work Phone / Telefono del Trabajo
Cell Phone / Celular *
Email / Correo Electronico: *
Highest Degree Completed / Mayor Licenciatura Obtenido *
My Degree was earned outside the US / Mi licenciatura fue ganado fuera de los Estados Unidos? *
Work Status / Situacion Laboral *
Ethnicity / Origen Etnico: *
Race / Raza: *
Total Years of School Completed / Total anos de Escuela Completados *
Majority of Schooling Outside United States? / Mayoría de la escolarización fuera de los Estados Unidos? *
Is English your second Language? / Es Inglés su segundo idioma? *
Do you have any Disabilities? / Tiene alguna incapacidad? *
Marital Status / Estado Civil: *
Primary Language? / Idioma Primario? *
Student Type/Personal Status - Tipo De Estudiante/ Estado Personal *
Required
Are you taking this class to help your child in school? / Estas tomando este clase para ayudar a su hijo/a en la escuela? *
Who referred you?/Quien te refirio? *
Emergency Contact Name / Nombre de Persona de Emergencia: *
Emergency Contact Phone Number / Telefono de Persona de Emergencia: *
Relationship to Emergency Contact/ Relacion de Persona de Emergencia: *
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