VRABE ESL PRE-REGISTRATION FORM

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Please fill in the form and click on SUBMIT at the bottom when done. This will let us know you are interested in taking an ESL class with us. Once this is completed, you will receive a separate online student registration form to fill out and submit. For info about our programs, visit www.vrabe.org or contact 860-870-6060. The next session will be fall classes.

You must live within one of the 14-towns we serve:

Last Name (as appears on your ID) * *

First Name (as appears on your ID) *

Nickname (Name you would like to be called, if different from first name)

Street #, Street name, Apt. # *

City *

State *

Zip Code *

Cell Phone Number *

Email Address *

Date of Birth *

YYYY

Are you a new or returning student? *

New (I have not taken ESL classes with VRABE before)

Returning

Do you have access to? (Check all that apply) *

Computer

Smartphone

Tablet

Internet

Required

Would you prefer online or in-person classes? *

Online ESL Class

In-person ESL Class

Would you prefer morning or evening classes? *

Morning ESL Class

Evening ESL Class

How long do you plan to live in the United States? *

Submit

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