Course Registration Form

East African Community Services

Citizenship Class Registration Form
Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Place of birth
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone
Marital Status

MarriedSingleDivorcedSeparated
If you are married, is your spouse an American citizen?
When did you come to the United States?
Languages spoken
Speaking English

Very wellNot badWith difficultyVery little
Reading English

Very wellNot badWith difficultyVery little
Writing English

Very wellNot badWith difficultyVery little
Do you have a green card?
If the answer is yes, when did you get your Green Card?
Have you applied for citizenship (N-400)?
If the answer is yes, when did you send in your application?
Have you ever failed a Naturalization test?
If the answer is yes, when was the interview?
Why did you fail the test?
Do you have an appointment for a Naturalization Interview now
If the answer is yes, when is the interview?
Are you vaccinated for Covid?
How many shots have you received?
Should be Empty: