Registration Form

Hudson Maynard Adult Learning Center

Registration Form 2020-2021
ENGLISH CLASS or GED Prep
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Cell Phone *
Please enter a valid phone number.
Can we text you at this phone number? *

Yes No
Email *
example@example.com
Gender *

Male Female
Date of Birth *

Month Day Year
Date
What country are you from? *
How long have you been in the United States? *
Are you currently employed? *

Yes No
Where do you work? *
How many hours do you work a week? *
Have you studied English before? *

Yes No
If yes, where?
Have you ever been on the Hudson English class waitlist? *

Yes No
Choose a class *

ESOL (English) Monday/Wednesday 6:30-8:30 pm ESOL (English) Tuesday/Thursday 6:30-8:30 pm ESOL (English) Either Monday/Wednesday OR Tuesday/Thursday 6:30-8:30 pm GED Prep Tuesday/Thursday 6:30-8:30 pm
Have you done online classes before? *

Yes No
Do you have internet at home? *

Yes No
Do you have a computer at home? *

Yes No
Privacy Policy and Statement of Confidentiality

I understand that my information will be viewed as confidential and used only for educational purposes. It wil be seen only by education staff members who are required to treat all student information as private.
*YOU WILL BE PUT ON A WAITLIST AND WE WILL CALL YOU IF THERE ARE ANY OPENINGS!
Comments?
Date: *

Month Day Year
Date
Should be Empty:

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Hudson Maynard Adult Learning Center