Language
English (US)
Spanish (Latin America)
Fall 2026 Registration Form
Community ESL
How old are you?
*
Name
*
First Name
Last Name
Home Address
*
Street Address
Apartment Number OR P. O. Box
City
State
What is your zip code?
Email:
*
example@example.com
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What Level do you want?
*
Basic Level
Level 1
Level 2
Level 3
Level 4
Level 5
Where and When do you want to take classes?
Lutheran Church of Our Savior 9:00 to 11:00 am Tuesdays and Thursdays
Lutheran Church of Our Savior 6:30 to 8:30 pm Tuesdays and Thursdays
Milford Avenue Methodist Church 6:00 to 8:00 pm Tuesdays and Thursdays
Are you a returning student?
*
Yes
No
Are you employed?
Yes
No
If you are employed, what is your job?
What is your gender
*
Female
Male
What method of communication do you want your teacher to use to communicate with you? Choose ONE
*
Text
Email
Telephone
WhatsApp
In what country were you born?
*
What is your native language?
What is your race?
*
American Indian or Alaska Native
Asian
Black or African-American
Native of Hawaii or other Pacific Islander
White
I prefer not to say
What is your ethnicity?
*
Hispanic or Latino
Not Hispanic or Latino
I prefer not to say
What level of education have you completed?
*
Primary School
Secondary School
University
Advanced Degree
None of the above
How many years have you lived in the United States?
*
How did you learn about this ESL Program? Choose one.
*
Friends
Facebook
Television or Radio
Church
Newspaper
Poster
Other
What is your main target? Check only 1.
Learn to speak or improve my English
Learn to read and write in English
Find a job
Enroll in college or continue my education
Attend a Parent-Teacher Conference
Obtain a driver's license
Get a job promotion
Other
The church sometimes uses photos of students in its marketing materials, such as on its Facebook page, its website, or in newspaper articles. Do you give the church permission to use your photograph in this way?
*
Yes
No
Emergency contact name
*
First Name
Last Name
How is your emergency contact related to you?
*
Example: husband, mother
Phone number of your emergency contact
*
Please enter a valid phone number
Format: (000) 000-0000.
Do you have any disabilities or require any accommodations to participate fully in this program?
Yes
No
If yes, please describe the accommodation {s} you require.
Do you have a laptop or a tablet at home connected to the internet?
Yes
No
Name
First Name
Last Name
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