EveryOne OnRegistration Form

Update

Our current class is full. You may register to join the waiting list!
Taller de Computación Básica

Fecha de inicio: 18 de junioUbicación: 3009 Middlefield Road, Redwood City, CA, 94063
Registration Form

I want to be a student
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Eres beneficiario de algún tipo del Gobierno?/Are you a beneficiary of any type from the Government?
¿Puedes probar que eres beneficiario?/Can you prove that you are a beneficiary?

Sí/ YesNo
Do you have previous experience using computers?
Who referred you to the program?/¿Quién te refirió al programa?

Juan Carlos MarquezNadia ZunoChristopher LunaKymberly HillSequoia District Adult SchoolEl Concilio
Upload the evidence - Subir las evidencias| Pictures - Fotografías *

Tome una fotografia de su tarjeta de WIC; SNAP o una fotografía de su recibo de energía.
Cancelof
Additional Comments
Should be Empty:

Update