Learner Registration Form

Learner Registration

This form will be used to match you with a private TALC English tutor, a TALC English class, or both. Following submittal, someone from TALC will contact you.
Learner Name:*

First/Given NameMiddle NameSurname/Last or Family
Preferred Name:
First Name
Year of Birth:*
Gender:*
Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone:*
Mobile phone preferred.
Email:*
Submitted form will be sent to this email.
Contact by:

Phone callText messageEmailOther
Interpreter or Helper:
To assist in contacting you for assignment.
Prior TALC Tutor?*
Have you had a TALC tutor in the past?
Native Language:*
Country of Origin:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Highest Education Level:*
Employment Status:*

EmployedLooking for workNot looking for work
Ethnicity:*

Native American/Alaska NativeAsianNative Hawaiian/Other Pacific IslanderBlack/African AmericanHispanic/LatinxWhiteOtherPrefer Not to Answer
COVID-19 Vaccination Status:
I Request:*

A personal tutor.A group class only.A tutor and a group class.
Meeting Format Preference:*

Fully onlineIn personMixture of online & in personNo preference
Meeting Location Preferences:

Downtown TacomaSouth TacomaEast TacomaWest TacomaNorth TacomaUniversity PlaceLakewoodFredricksonParkland/SpanawaySumnerBonney LakePuyallupBuckleyFife/SummitGig Harbor
Class Location Preference:*

SumnerParkland

English Skill Levels:*

English Goals:*
Autobiography:*
Meet Times:*

WeekendsEveningsDuring the school day (9-3)Other
Tutor Gender Preference:*
How did you hear about TALC?

Friend or relativeNewspaper or posterImmigrant or refugee organizationEmployerLibraryTALC WebsiteSocial MediaOther
Other Information:
Status Code
Should be Empty: