Learning Lab Registration
If you need help completing this form or have any questions, please email alishav@learninglabinc.org
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What is your first and last name? *
What is your gender?
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What is your phone number? *
What is your email?
Do you have children between 3 months-old to 5 years-old that you would like to bring to class?
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If you have children you would like to bring, what are their names and birthdays?
What would you like to work on in class?
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When would you like class?
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Where would you prefer to have class?
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What is your English level?
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How many people live in your house?
How much money do you (and your spouse) make in a year?
What is your birthday?
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DD
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What is your address? (example: 308 E 36th St. Garden City, Idaho 83714)
What is the name of your emergency contact?
What is the phone number of your emergency contact?
Why do you want to be in class?
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Where are you from?
What's your first language?
When did you come to the United States?
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What is your race?
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What is the last grade you completed in school?
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Did you attend school in the United States?
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What is your employment status?
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How did you hear about Learning Lab?
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Is there anything else we should know about you?
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