Placement in Class
Beginner Level 1
Beginner Level 2
Intermediate
Advanced
Conversation Class Weeknight
Other
Contacted by
English Student Registration Form
Fill out the form carefully for registration. You'll be asked to click submit at the bottom of next page.
Student Name
*
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
*
example@example.com
Phone Number
*
Can we text you?
*
Please Select
Yes
No
Answer Yes or No
Birth Date
Please select a month
January
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Month
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1
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Day
Please select a year
2024
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1928
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1924
1923
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1921
1920
Year
Gender
*
Please Select
Female
Male
Other
Prefer not to say
What country are you from (before the United States)?
*
Type in your country, e.g., Brazil, Turkey, etc.
Have you taken English classes before?
*
Please Select
Yes
No
Answer Yes or No
If you took classes before, what level did you take?
Please Select
Beginner 1
Beginner 2
Intermediate
Advanced
Look at the options and select by name or class level.
Your estimated skill level of English
*
Please Select
1.Beginner Level 1 (No English or a few English words. Difficulty following English instructions.)
2.Beginner Level 2 (Can read and respond in short phrases and answer general questions.)
3. Intermediate Level (Can answer and comprehend some reading and can think in English)
4. Advanced Level
How well can you speak, read and write English?
How long have you been in the United States? Give a number and say "months" or "years". Please use English.
Please state number of years or months.
How will you connect with the online class?
*
Please Select
Laptop/computer
Smartphone (accesses internet)
iPad or Tablet
NOTE: Both computers and smartphones can access the classes using ZOOM.
Do you have capability to print files emailed to you?
*
Please Select
Yes
No
Answer Yes or No
Have you used Zoom before to meet online?
*
Yes
No
What do you want to study the most? Use English.
Speaking, grammar, vocabulary, or other?
Write a few sentences in English describing what you have been doing during your time in the United States. (What is your job in the United States? What hobbies or other activities do you enjoy doing?)
*
Our classes are 1) Beginner Level 1, Monday 7:30 - 8:30 p.m. 2) Beginner Level 2, Sundays 5:30-6:30 p.m. 3) Intermediate: Fridays 8-9 p.m. and optional Harry Potter Book Club, Wednesday 8-9 pm 4) Advanced Sundays 6-8 p.m. Looking at the above schedule, which classes are your preference?
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Next
Assessment
New and all returning students: Please complete the following questions as part of the registration process. Do not get assistance from anyone. Do this on your own. This will help us determine what we should include in our teaching and your English skill level. * Select the correct answer by clicking on the white circle by your chosen answer.
1. My __________ is 195 Pine Street
address
house
direction
2. Her first name is Lucy. What’s __________ last name?
she
his
her
3. How much __________ the rent?
be
is
our
4. __________ your mother have short hair?
Does
Is
Do
5. We have class ______ Monday.
at
in
on
6. Yesterday my brother __________ a new car.
buy
buyed
bought
7. Lisa got a ticket. She __________ and texting.
drives
was driving
were driving
8. Cindy's restaurant is ____ Center Street.
at
on
in
of
9. Donna loves dancing, but she ______ like to play sports.
doesn't
don't
not
no
10. Not everyone enjoys ______ for clothes.
shop
shopping
to shop
they shop
11. There isn't ________ milk in the refrigerator.
a
any
a few
some
12. If I could take a trip anywhere in the world, __________ to Australia.
I'll go
I'd go
I've gone
I'm going
How did you hear about our English classses? ESLIM website? Community of Christ Website? Community of Christ front sign? Referred by a friend (please give us the name of your friend). Or other source?
(Example: Searched online
Your registration is complete. Please click on the Submit Application button below
Required Answer: Did someone help you understand the vocabulary or assessment questions on this form?
*
Yes
No
Submit Application
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