Student Application

Fill out the application below. To translate into your native language, use the translate button on the top of the page.

Name

Gender

Male Female

Address

Date of Birth

Email

Home Phone

Cell Phone

Contact Person (English Speaking)

Contact Person Telephone Number

Have you ever applied to our program before?

Yes No

**Sessions are two hours per week and you must be able to attend for 12 consective months.**
In which program are you interested? (Choose One)

Basic Literacy (Reading & Writing English) English for Speakers of Other Languages (Speaking, Reading & Writing English)

Fill out the following section if you checked off Basic Literacy:
Where did you attend school?

What was the last grade you completed?

Fill out the following section if you checked off English for Speakers of Other Languages:
What is your primary language?

What is your native country?

Can you speak any English at all?

Yes No

What times are you available to meet the tutor? (Check as many as possible)

Monday morning Monday afternoon Monday evening

Tuesday morning Tuesday afternoon Tuesday evening

Wednesday morning Wednesday afternoon Wednesday evening

Thursday morning Thursday afternoon Thursday evening

Friday morning Friday afternoon Friday evening

Saturday morning Saturday afternoon Sunday morning Sunday afternoon

What library is your first choice to meet at?

What library is your second choce to meet at?

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