ESOL Class Registration

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Thank you for your interest in our FREE English for Speakers of Other Languages (ESOL) program. We are excited to offer this opportunity to help you improve your English skills!

Program Details:

ONLINE: Tuesdays 7:00pm - 8:00pm
IN PERSON: Thursdays 7:00 PM - 9:00 PM
Location: 73 Brooks Street, Brighton MA, 02135
Format: HYBRID

Please fill out the registration form with the information for the person attending the class. If you're completing the form for someone else and prefer to be the main contact, enter your details in the Secondary Contact Information section.

We will contact you by text, call, or email to confirm your registration.

If you have any questions, feel free to contact us at bupcoutreach@gmail.com.

You can also visit our website https://www.bostonupc.org.

We look forward to welcoming you to our classes!

Email *

Last Name *

First Name *

Middle Initial

Suffix

Example: Jr., Sr., The 3rd, etc.

Cell/Mobile Phone (Primary) *

Phone (Secondary)

Email (Secondary)

Contact Preference *

Phone

Text Message

Required

Date of Birth *

YYYY

Sex *

Home Address *

City *

State *

Zip Code *

What is your race? *

Alaskan Native/American

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other:

Required

Are you Hispanic/Latino? *

What language do you speak most often at home? (Your Native Language)

What is your Country of Birth? *

Highest school level: (Select one)
*

I did not attend school

Grade 1-5

Grade 6-8

Grade 9-11

High School Diploma

Some College, No Degree

College Degree

Graduate Degree

Please select the option that best describes your work status.
*

Working Part Time (Less than 30 Hours)

Working Full Time (30 Hours or More)

Not working

Retired

Do you have any disabilities you wish to disclose? (Disclosure is optional)
*

Yes

Prefer NOT to answer

Please explain your disabilities here: (Disclosure is optional)

Will you require special in class accommodations? *

Yes

Maybe

If you answered yes to accommodations please explain:

Which of the following public assistance services do you need help acquiring?
*

EAEDC (Cash Assistance)

MassHealth (Health Insurance)

SNAP (EBT/Food Stamps)

WIC (Women, Infants, and Children Nutrition Program)

None (I DO NOT NEED any public assistance)

None (I ALREADY RECEIVE public assistance)

Other:

Required

By checking 'Yes,' I consent to receive text messages regarding classes and my enrollment status.
*

Yes, I consent to receive text messages.

No, I do not consent to receive text messages.

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