New Life Pentecostal Church English Class Registration Intake 2024

English Registration Form
Name*

First NameLast Name
Date*

MonthDayYear
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry of Birth
Student E-mail
Phone number*

Area CodePhone Number
Gender*
Do you prefer?*

Phone CallTextEmail
Best time of day to contact*

MorningAfternoonEveningOther
U. S. Citizen?*

YesNo
Do you have any children under the age of 18?*

YesNo
How many?*
Emergency Contact*
Phone Number*

Area CodePhone Number
Relationship of Emergency Contact*
Educational Status*
Highest grade completed
Location of final education attained*
Are you Hispanic/Latino*

YesNo
Hispanic/Latino*

Not Hispanic/LationHispanic/Lation (A person of Cuban, Puerto Rican, South or Central America, or other Sapnish culture or origin, regarless of race)
Race*
Are you employed?*

YesNo
Name of Employer?*
Are you seeking employment?*
How did you hear about Classes?*
Have you been enrolled in Adult Education Classes before?*

YesNo
Where?*
Do you have a documented disability?

YesNo
If yes, what?
Goals-Check all that apply*

Obtain High School EquivalencyImprove English Oral/Speaking SkillsImprove Literacy Reading/Writing SkillsEnter EmploymentEnter Post-Secondary education or job trainingNone of the Above
Optional Goals

Increase Involvement in Children's EducationIncrease Involvement in Community ActivitiesLeave Public AssistanceObtain Citizenship SkillsRegister to Vote or Vote
Are you interested in attending a Bible Study Group?*

YesNoNot sure
Will anything prevent you from coming to class on a regular basis?*

YesNo
Please select*

Work obligationsFamily obligationsTransportationOther
Days

MondayTuesdayWednesdayThursdaySaturday

How would you rate your English speaking?*

	1	2	3	4	5

1 is Low, 5 is High

How would you rate your English writing?*

	1	2	3	4	5

1 is Low, 5 is High

Have you studied English before?*

YesNo
Times

Morning (Before 12pm)Evening (After 5pm)
Upload a photo ID of any country *

Browse Files

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After clicking "Submit Application" button, you will be redirected to an appointment scheduler. From there you will be able to select an appointment date and time to complete registration and pre-testing.
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English Registration Form