Caminos CPS interest form
Thanks for your interest in this course. We are sure it will bring you joy and a different perspective over your professional development. Please, sign in the following form.
Full Name
*
First Name
Last Name
Today's date
*
-
Month
-
Day
Year
Date
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
What is your prefered schedule for taking the class?
*
9:30am -1:30pm
4pm - 8pm
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is your interest in this course?
What is your age?
*
What is your race/ethnicity
Please Select
Black/African American
American Indian and Alaskan Native (Cherokee, Chippewa, Navajo, Sioux)
Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Hmong, Other Asians)
Native Hawaiian and Other Pacific Islander (Guamanian, Chamarrow, Saamoan)
Hispanic/Latino (Mexican, Puerto Rican, Cuban and other Hispanic or Latino)
White, Not Hispanic or Latino
From the following list, please check the items that apply to you
*
Completed High School or GED/HSED Diploma
Completed High School in the country of origin (must have access to original documents)
18 years old
Authorized to legally work in the United States
English Language Learner at an Intermediate or Advanced Level
Please indicate your English level
*
Beginner
Intermediate
Advanced
How did you hear from this program?
*
Word of mouth
Flyer
La Movida Radio
Facebook
Instagran
LinkedIn
Other
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