Tri-Cities ROP Program Update Form
2017-2018
Please fill out the form below when registering for our adult courses. The information you provide will help fund the program and keep fees/costs as affordable as possible. If you do not understand some of these statements or questions, please provide your best response and we will address it at a later time.

If you have any questions or concerns, please give us a call at (562) 698-9571.

Student Name: *
Your answer
What is your Date of Birth? *
example: month/day/year = 3/15/1965
Your answer
Which ROP class are you registering for or which one are currently taking? *
What is your current employment status? *
Click on the circle that applies to you, the circle will be filled in with a color when you click on it.
Are you Hispanic or Latino? *
Race: *
Select one or more boxes that apply
Required
How many years of school have you completed?
example: middle school = 6 years, completed high school = 12 years, some college = 14 years
Your answer
Most of my schooling was outside of the U.S: *
Highest Certificate, Diploma, or Degree Earned:
Click on the circle that applies to you
I earned the above certificate/diploma/degree outside of U.S.:
What is your Native Language?
Click on the circle that applies to you
What is your Primary/First goal by taking our classes? *
Click on the circle that most applies to you
Which Special Programs apply to you?
Click on one or more boxes that applies to you.
Which Employment Barriers apply to you?
Click on one or more boxes that applies to you or leave all blank if none apply
Which of these Personal Status apply to you?
Click on one or more boxes applies to you or leave all blank if none apply
Submit
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