Adult Registration Form | 2020-2021 School Year


UNTIL 2021, ALL CLASSES WILL BE ONLINE
Name: *
Phone Number *
Email Address:
Address: *
Date of Birth: *
Place of Birth:
Age:
Gender:
Clear selection
How long have you been in the USA?
Native Language:
Clear selection
Marital Status:
Clear selection
Do you have children? How many?
How many people are in your household?
Emergency Contact Name and Phone Number:
What is the highest level of education you have completed?
Where else have you attended ENGLISH classes?
Are you a new or returning student?
Clear selection
Do you have access to a computer?
Clear selection
Do you have access to the internet?
Clear selection
Tutoring Needed In: *
Required
Availability
9 - 10am
10-11am
1-2 pm
2-3 pm
3-4 pm
4-5 pm
Monday
Tuesday
Wednesday
Thursday
Friday
I give my permission to be photographed or recorded for purposes of distance learning activities and for my voice and image to be transmitted and viewed by instructors involved in distance learning activities at Good Counsel Learning Center. *
Submit
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