Trellus Adult Education Registration

Adult Education Registration
v20260825
Please fill out form to enroll.

New students must come in for an English test on scheduled Registration Days.
- Testing (speaking, writing, reading) will take 2-3 hours
- Come to 2838 W. Peterson Ave, Chicago, IL 60659 (CTA bus 84, 93, 11)
- If you have not receive the scheduled date & time, text (773) 293-8457 or email adulted@mytrellus.org
Dates for {termName} term:
- {termDates01} {classes01}
- {termDates02} {classes02}
{termName} = Term Name & Year (e.g., Spring YYYY)
To edit, go to Properties > Advanced > Default Value
{termDates01} = Month DD - Month DD
To edit, go to Properties > Advanced > Default Value
{classes01} = (Comma separated, in parentheses)
To edit, go to Properties > Advanced > Default Value
{termDates02} = Month DD - Month DD
To edit, go to Properties > Advanced > Default Value
{classes02} = (Comma separated, in parentheses)
To edit, go to Properties > Advanced > Default Value
Let's get started! Please answer in English.
- Пожалуйста, пишите свои ответы на английском языке.
- Por favor conteste en inglés.
- الرجاء كتابة الإجابات باللغة الإنجليزية
Questions? Email adulted@mytrellus.org
Which class are you enrolling in?
Name

First NameMiddle NameLast Name
Preferred / Nickname
Gender Identity
Pronouns
Email
Call Back Phone Number
Format: (000) 000-0000.
How do you want to communicate with Trellus?
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Phone Number
Format: (000) 000-0000.
Relationship to You

Language, Education, Employment
Language most comfortable speaking
Language
Secondary Language (if applicable)
Secondary Language
English Skill Level
↓
Highest Level of Education
Highest Grade
Are you working?
Employment Status
Job / Occupation?
Reason for Not Working

Goals
Select a career that you want to learn about.
Questions or comments?

Consent
I acknowledge that the above information is correct, and that Trellus can use that information to match me with appropriate programs & services. Information provided in this form is confidential.
Provide consent
Signature
Signature Date

{signatureDateDisplay}
Should be Empty:

Adult Education Registration

Please fill out form to enroll.

Dates for {termName} term:

Let's get started! Please answer in English.

Official Information

Language, Education, Employment

Housing & Internet

Goals

Future Programs & Services

Consent