Literacy Support Program Interest Form

Thank You for your interest!

Our new programing is designed with you in mind. Please complete to help us best serve you, our neighbor.
Email Address
example@example.com
DOB

MonthDayYear
Date
What days/times work best for you?

Saturday AfternoonMonday EveningThursday Evening
What type of instruction would you prefer?

In-PersonVirtual/OnlineHybrid (option for both in-person & virtual)
Which literacy programs interest you? (choose all that apply)

GED PreparationReading SupportMath SupportBasic Computer SkillsFinancial Literacy
Are you interested in CPR training for teens?

YesNo
What type of training interests you? (choose all that apply)

Basic CPR AwarenessHands-Only CPRFull Certification CourseBabysitting Safety + CPR
Which cooking classes interest you? (choose all that apply)

Budget CookingFamily Meal PrepBeginner Cooking SkillsQuick Healthy MealsCooking for One
Which nutrition topics interest you? (choose all that apply)

Healthy Eating BasicsReading Food LabelsDiabetes-Friendly MealsNutrition for FamiliesWeight Management
Which Physical Health activities interest you? (choose all that apply)

Fitness ClassesGroup Walking/HikingBoxing BootcampYouth Boxing BootcampDancingYoga
Please share your feedback or suggestions.
Should be Empty:

Thank You for your interest!