ESOL Registration FY2023

Abisi Adult Education Center
Welcome to ESOL Registration

2022-2023 School Year
*You must be at least 18 years of age, have a photo ID and proof of address that includes YOUR name and address in the greater Lowell area*

The greater Lowell area includes Lowell, Billerica, Chelmsford, Dracut, Dunstable, Tewksbury, Tyngsboro and Westford.
Registration for evening classes is closed for the current school year. You may register for morning classes until March 30th.
REGISTRATION IS NOT A GUARANTEE OF CLASS PLACEMENT.

Classes are filled on a first come first serve basis. There may be a waiting list, or changes in classes due to circumstances beyond our control. Click Submit when you are finished with your registration and release forms. Only submit your forms ONCE. Duplicate forms will be deleted.

1st Child Date of Birth*

MonthDayYear
Name of Child's School*
Select your child's school from the drop down list. Select "Other" if your child's school is not on the list.
2nd Child Date of Birth

MonthDayYear
Name of Child's School
Select your child's school from the drop down list. Select "Other" if your child's school is not on the list.
3rd child Date of Birth

MonthDayYear
Name of Child's School
Select your child's school from the drop down list. Select "Other" if your child's school is not on the list.
4th Child Date of Birth

MonthDayYear
Name of Child's School
Select your child's school from the drop down list. Select "Other" if your child's school is not on the list.
Please provide a date of birth and name of school for any additional children. Example: #5. 01/05/2015, Murkland. #6. 09/20/2020, Daycare

I am*

Working for a company or another individualSelf EmployedWorking without pay for a family member
Average number of hours worked each week *
Earnings ($) per hour*
Please enter a whole dollar amount
Occupation*
Examples: Cashier, Waiter, Machine Operator, Housekeeper, etc.
Employer/Company Name*
Examples: Dunkin Donuts, Market Basket
Employer/Company Location (City or Town)*
Example: Lowell
Start Date of Current Job (select "January" for month and "1" for day if you cannot remember the exact date)*

MonthDayYear
If you are employed at more than one job, please tell us about your other job(s) (employer, occupation, hours worked each week, pay rate)
Example: Dunkin Donuts, Cashier, 20hrs, $12

I am*

Disabled/Unable to WorkRetiredLooking for workNOT looking for work

YOU ARE NOT REQUIRED TO DISCLOSE MEDICAL OR DISABILITY INFORMATION.

You are not required to disclose medical or disability information as a condition of enrollment. Any information you do share will be kept confidential and will not be shared without your permission. You may be entitled to accommodations for disabilities that you disclose.
Do you agree to share your medical/disability information with AAEC staff?*

YesNo

Emergency Contacts

Please provide information for 2 people that we may call in case of an emergency. Your contact should be at least 18 years of age. (It is very helpful for staff if your contact speaks English and lives in the area.) *Please enter "None" if you do not have an emergency contact.
Contact #1 Name*
Name (type "None" if you do not have an emergency contact)
Contact #1 Phone
Please enter a valid phone number.
Contact #1 Language
Contact #1 Relationship to student
Examples: Wife, Husband, Son, Daughter, Friend
Contact #2 Name*
Name (type "None" if you do not have a second emergency contact)
Contact #2 Phone
Please enter a valid phone number.
Contact #2 Language
Contact #2 Relationship to student
Examples: Wife, Husband, Son, Daughter, Friend

All students must take a placement test. This is a short speaking and/or reading assessment that can be done in person or remotely (online using Zoom). How do you want to complete your placement test?*

In PersonRemotely (online using Zoom)I am willing to complete the test in person or remotely

Please read and sign the following two release forms:
Massachusetts Department of Elementary and Secondary Education

Adult and Community Learning Services Release of Information Form
Dear Student:

The Massachusetts Department of Elementary and Secondary Education (DESE) funds your adult education program, Abisi Adult Education Center, and almost 100 others like it. In order to continue to support these programs, DESE must report information about students, including student outcomes, to the federal government.

After students leave their program, DESE collects information about their outcomes by matching their personal information with Department of Unemployment Assistance employment data, with GED and HiSET high school equivalency (HSE) test results, and with National Student Clearing House and Department of Higher Education postsecondary enrollment records. DESE combines the data sets and reports them to the federal government.

If you sign this Release of Information form, DESE will also share your employment data, HSE test results, and postsecondary enrollment information with your program, Abisi Adult Education Center, so it can understand how well it is helping students. DESE and your Adult Education program will not disclose this confidential information under any other circumstances unless required to do so by law.

Thank you.
I agree to the release of information as described above.*

YesNo
Signature (Use your mouse or stylus if you are on a computer/laptop; use your finger if you are using a smartphone or tablet with a touch screen)

Clear
Type your name. This will serve as your electronic signature if you are unable to sign above.*

First NameLast Name
Date

MonthDayYear
Date

Abisi Adult Education Center-Media Release Form

I give the Abisi Adult Education Center permission to use my photograph and name in any Abisi Adult Education Center publications. I understand that this includes photos, newspaper articles, newsletters, videos, commercials, websites, and any other media publications related to the Abisi Adult Education Center. Sound and video from remote classes may be recorded.
I agree to the use of my image or name as described above*

YesNo
Signature (Use your mouse or stylus if you are on a computer/laptop; use your finger if you are using a smartphone or tablet with a touch screen)

Clear
Type your name. This will serve as your electronic signature if you were unable to sign above.*

First NameLast Name
Date

MonthDayYear
Date

Is there anything else you would like to share with us?

Your registration and release forms are now complete. Please click "Submit" to finish the registration process.
Should be Empty:

Abisi Adult Education Center

Welcome to ESOL Registration

*You must be at least 18 years of age, have a photo ID and proof of address that includes YOUR name and address in the greater Lowell area*

Registration for evening classes is closed for the current school year. You may register for morning classes until March 30th.

REGISTRATION IS NOT A GUARANTEE OF CLASS PLACEMENT.

YOU ARE NOT REQUIRED TO DISCLOSE MEDICAL OR DISABILITY INFORMATION.

Emergency Contacts

Please read and sign the following two release forms:

Massachusetts Department of Elementary and Secondary Education

Abisi Adult Education Center-Media Release Form

Your registration and release forms are now complete. Please click "Submit" to finish the registration process.

You must be at least 18 years of age, have a photo ID and proof of address that includes YOUR name and address in the greater Lowell area