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Adult Program Application
Immigrant Home English Learning Program provides free one-on-one English language or Citizenship classes to adult immigrants who live in the St. Louis metro area. The classes are in-person in the student’s home, or online, using a phone, tablet, or computer. Please note: students must provide their own device for online classes. Students must be able to commit to two, one-hour tutoring sessions per week. Our program is individually paced and based on each student’s needs, goals, and abilities. Adult students may participate in the IHELP program for up to 3 years. IHELP program staff will review this application, and we will text you to let you know if you are eligible. If you are eligible, you will be on our waitlist for a tutor. You may be on the waitlist for 6-18 months. If you have problems with this form or any questions, you can call or text us at 314-771-1104. All of the information you provide here will remain confidential. Thank you for your interest in our program! Note: If you are completing this application for someone else, fill out their information unless otherwise indicated.
If you are completing this application for someone else, what is your name?
If you are completing this application for someone else, what is your phone number?
Please enter a valid phone number.
Format: (000) 000-0000.
Name
*
First Name
Last Name
Preferred Name
Today's Date
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-
Month
-
Day
Year
Date Picker Icon
Student Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I consent to receive text messages from IHELP (This is only to communicate with you about English classes).
*
Yes
No
Email address
Gender
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Female
Male
Non-Binary
Date of Birth
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-
Month
-
Day
Year
Date Picker Icon
Country of Origin
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What languages do you speak?
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Preferred language
*
Do you need interpretation to talk to staff about your English classes?
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Yes
No
Can you read and write in your home language?
*
Yes
No
Somewhat
What year did you arrive in the USA?
Do you want in-person or online classes?
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In-person only
In-person preferred
Online only
Online preferred
No preference
For in-person classes, are there many stairs leading to your home or apartment?
Yes
No
For in-person classes, does anyone smoke in the home?
Yes
No
For in-person classes, are there any pets in the home?
Yes
No
If you have pets, how many and what kind (cat, dog, bird)?
In general, are you able to attend two, 1-hour classes each week? (A total of two hours per week)
*
Yes
No
Is anyone else in the family applying to the program?
Yes
No
If yes, what is the person's name?
Why are you unable to attend class outside the home? (Select all that apply.)
Lack of childcare
Lack of transportation
Fear or anxiety about attending group classes
Job schedule conflicts with class
No classes offered nearby
Health issues
Other
What are your goals for learning English? (Select all that apply.)
*
General Communication
Literacy
General Life Skills
Citizenship
Driver's License
Employment
Continue your Education
Communicate with medical providers
Communicate with child's school and teachers
Shopping
Involvement in child's education (help with homework)
Other
Is there anything you would like to add about your goals?
What subject do you want to study?
*
English
Citizenship
Both English and Citzenship
If you want to study citizenship, when will you be eligible to apply?
Eligible now
Eligible now, but I am a beginner in English
Will be eligible in 1-2 years
Will be eligible in 1-2 years, but need practice with English
Eligible in 3+ years
Unknown
When are you available to meet with a teacher? (Select all that apply.)
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Morning
Afternoon
Evening
Weekends
Other
Please provide any useful information about availability (work schedules, childcare, or specific days and times you are available).
Do you prefer a female or male teacher?
*
Female only
Female preferred
Male only
Male preferred
No preference
Highest level of education:
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0 years
1-6 years
7-9 years
10-12 years
University
Current level of English proficiency:
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Complete beginner (no spoken or written English)
High beginner (know the alphabet, some basic phrases)
Intermediate
Advanced
Do you have any physical or mental challenges that might make English class more difficult? Are any accommodations needed to make learning English successful? IHELP may not have the resources to provide all accommodations. We will try to help find the right program if we cannot serve you.
Will other people regularly be in the home during class time?(Select all that apply)
*
Yes, children (0 - 17 years old)
Yes, other adults
No
If you have children, please select their grade level in school (Select all that apply).
Pre-K or younger
Kindergarten - 5th grade
6th grade - 8th grade
9th grade - 12th grade
Is there anything else about your home or family situation that would impact English classes?
Are there other phone numbers where we can call you? (Write the contact name and number below)
Is there anything else we should know in order to match you with a teacher?
Signature
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