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Digital Skills Class Registration
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Last Name
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First Name
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Age
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18-34
35-54
55+
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Learner Gender
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Gender Fluid
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Address
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Phone No.
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Emergency Contact
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Education
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K - 6
7 - 9
High School/Diploma
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Immigration Status
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1st Language/ Mother Tongue
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Other Language
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What is your learning goal ? (e.g. to learn email, to learn about your phone/ipad)
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Who referred you to this class?
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E-mail
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Signature
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Date of Registration
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