Language
English (US)
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Haitian Creole
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English Program Waitlist
Thank you for your interest in the ESL program at the International District Community Center (IDCC). By completing this form, you will be added to our waitlist. If a spot becomes available in one of our current classes or if we open a new class, we will contact you by email. We appreciate your patience and look forward to supporting you on your English language learning journey!
Email
*
example@example.com
Secondary Email
example@example.com
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
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Demographic Profile
Age
*
Under 18
18 - 25
26 - 35
36 - 45
46 - 60
60 +
Gender
*
Male
Female
Non-Binary
Prefer not to say
Other
Native Language
*
Spanish
French
Haitian Creole
Mandarin Chinese
Dari
Arabic
Other
Country of Origin
*
How long have you been in the U.S?
*
Under 1 year
1-3 years
4-6 years
Over 6 years
Are you interest in English classes for other family members?
*
Yes
No
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Family Participation in English Program
How many family members are interested in taking English classes?
*
1
2
3
4
5+
Interested Family members
*
Spouse/Partner
Child
Parent
Sibling
Other
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Education and Employment Background
Highest Level of Education Completed
*
No Formal Education
Primary
Secondary
Some college
College degree
Postgraduate
Other
Current Employment Status
*
Employed full-time
Part-time
Self-employed
Unemployed
Student
Homemaker
Retired
Other
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English Language Experience
English Proficiency Level (Self-Assessment)
*
Beginner
Intermediate
Advanced
Have you taken an English class before?
*
Yes
No
If yes, for how long?
Areas of Difficulty in English (choose all that apply)
*
Speaking
Listening
Reading
Writing
Grammar
Other
Primary Goal for Learning English
*
Job advancement
Academic purposes
Daily communication
U.S. citizenship
Social integration
Other
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Additional Needs or Concerns
Would childcare support make it easier for you to attend the English classes?
*
Yes
No
Please share any challenges or support you would need to participate in the program.
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