ESOL Registration

Abisi Adult Education Center
Welcome to ESOL Registration

September 2023-June 2024 School Year
*You must be at least 18 years of age, have a photo ID, and proof of address in the greater Lowell area. Your proof of address must include YOUR name.*

The greater Lowell area includes Lowell, Billerica, Chelmsford, Dracut, Dunstable, Tewksbury, Tyngsboro and Westford.
REGISTRATION IS NOT A GUARANTEE OF CLASS PLACEMENT.

Classes are filled on a first come first served 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 form ONCE. Duplicate forms will be deleted.

Child #1 Birth Date*

MonthDayYear
Child #1-Name of School*
Child #2 Birth Date

MonthDayYear
Child #2-Name of School
Child #3 Birth Date

MonthDayYear
Child #3-Name of School
Child #4 Birth Date

MonthDayYear
Child #4-Name of School
Child #5 Birth Date

MonthDayYear
Child #5-Name of School
For any additional children, please type their date of birth and name of their school:

Employer/Company Name
Employer/Company Location (City or Town)
Occupation*
Start Date of Current Job

MonthDayYear
Number of hours worked each week*
Salary per hour worked*
Please enter a dollar amount

I am*

Looking for workNOT looking for workRetiredDisabled/Unable to 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.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Language
Relationship to student
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Language
Relationship to student

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 PersonRemotelyI am able to complete the test remotely or in person

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
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

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

First NameLast Name
Today's Date

MonthDayYear
Date

Technology
I have a smart phone*

YesNo
I have a computer with a camera*

YesNo
I have access to the internet*

YesNo
I know how to use the Zoom application on my computer or phone*

YesNo

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 in the greater Lowell area. Your proof of address must include YOUR name.

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

Technology

Class Preference

Please be aware, class start and end times vary by location. However, morning classes begin no earlier than 9:00 a.m. and end no later than 1:00 p.m. Evening classes begin no earlier than 5:00 p.m. and end no later than 9:00 p.m.

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

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 in the greater Lowell area. Your proof of address must include YOUR name.*

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

Technology

Class Preference

Please be aware, class start and end times vary by location. However, morning classes begin no earlier than 9:00 a.m. and end no later than 1:00 p.m. Evening classes begin no earlier than 5:00 p.m. and end no later than 9:00 p.m.

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 in the greater Lowell area. Your proof of address must include YOUR name.