Registration Form
Connect Language Center
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example@example.com
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Address
*
Street Address
Street Address Line 2
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Emergency Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
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Work and Education
Please complete this form to complete your enrollment for classes.
First language learned
*
Languages Spoken
*
Please list them
Highest level of Education
*
Please Select
Elementary School
Middle School
High School/GED
Technical
College/University
Master/PhD
Current Employer/Job/Occupation
*
Example: Construction, cleaning houses, Chick-fil-a, student, driver, notary, government, homemaker, etc
Previous Occupation in your Country
*
Example: student, lawyer, construction, factory, doctor, farming, teacher, homemaker, artist, etc
How long have you been living in the United States of America?
*
Did you come to the USA as a refugee or asylee with an I-94?
*
Please Select
Yes
No
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Classes
Please complete this form to complete your enrollment for classes.
Why do you want to study English?
*
Community Integration
Better Job
Citizenship
Other
Have you taken classes with us before? When?
*
Examples: Yes, Summer 2023. Yes, I took Private Lessons. No, I have not.
What Course are you interested in?
*
Group Classes
Private Lessons
Group Classes and Private Lessons
Other
What times would you prefer to take classes?
*
Mornings (9:30 am-11:30 am)
Evenings (6:30 pm-8:30 pm)
Any time
Other
What days are you available to come to class?
*
Tuesdays and Thursdays
Any day
Other
What is your confidence level when speaking English?
*
No confidence
1
2
3
4
5
6
7
8
9
A lot of Confidence
10
1 is No confidence, 10 is A lot of Confidence
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Payment to join classes
Please complete your payment to submit your registration. This payment will secure your spot into a group for English classes or Private Lessons. Please note that to open a class we will need at least 6 students. If the class does not make, we will proceed to reimburse your money.
How do you want to pay? Please select one of the options bellow:
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