TLC Learner Intake Form

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Fill out this form to begin your journey. Someone from our office will contact you shortly.

Name *

Home Address *

Phone Number *

Today's Date *

YYYY

What is your highest level of education? (Last grade level completed?) *

Some high school

Grade 12

Some college/university

Post secondary (completed college/university)

Other

Are you currently....? *

What is your goal? *

How did you hear about our program? *

At which site would you prefer to learn? *

How do you prefer to be contacted? *

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