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East Side Adult Education IET ESL/ABE Registration Form
ESL/ELL Please take time to complete the information below. You will learn English & a job skill at the same time.
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Email
*
Your email
I would like to enroll in one of the IET Programs.
*
Choose
Intro to Microsoft Office Skills - Excel TWTH 6:00P-9:10PM
Intro to the Language of Early Childhood Education
English For Accounting & Bookkeeping TWTH 6:00PM-9:10PM
DISTANCE LEARNING EVENIING
Student Registration
New Student
Returning Student
SCHOOL Student ID# (9 numbers)
Your answer
Name: First & Middle
*
Your answer
Name: Last
*
Your answer
Address: Street
*
Your answer
City
*
Your answer
State: CA
Zip Code
*
Your answer
Primary Contact Number
*
Your answer
Is this a cell phone?
*
Yes
No
Secondary Contact Number
Your answer
Emergency Contact: Name
*
Your answer
Emergency Contact: Relationship
*
Your answer
Emergency Contact: Phone Number
*
Your answer
Gender
*
Choose
Male
Female
Non-binary
Date of Birth
*
MM
/
DD
/
YYYY
Are you Hispanic or Latino?
*
Yes
No
Race (check all that apply)
*
American Indian
Alaskan Native
Black/African American
Asian
Fillipino
White
Native Hawaiian or Other Pacific Island
Other
Required
Native Language (check one)
*
Choose
English
Spanish
Chinese
Tagolog
Vietnamese
Cambodian
Korean
Hmong
Arabic
Russian
Farsi
Somali
Other
Highest Year of Schooling Completed (check one) Note: High School completion equals to completion of 12th Grade in the U.S. Please mark correctly.
*
Choose
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Majority of my school was outside of the U.S
*
Yes
No
Required
Highest Degree Earned ( check one)
*
Choose
None
HSE Certificate
High School Diploma
Technical Certificate
A.A./A.S/Degree
4 year College
Higher than B.A./B.S
Some College, no degree
Earned above outside of U.S
*
Yes
No
Please continue to complete more information. My attainable goals within the program year. Please select two.
*
Improve basic skills
Improve English skills
H.S Diploma/HSE
Get a job
Retain a job
Get a better job
Enter college or training
U.S. Citizenship
Required
Special Programs. (Mark all that apply)
*
None
EL Civics (IELCE)
Family Literacy
Required
Employment Status
*
Choose
Employed
Employed with notice
Unemployed
Not in labor the force e.g. retired, full-time student, homemaker
Employment Barriers (Mark all that apply)
*
Cultural Barriers
Disabled
English Language Learners
Low Income
Low Levels of Literacy
Single Parent
NA (Not Applicable)
Required
Registration Completion Date
*
MM
/
DD
/
YYYY
Thank you for completing our online registration form. You will be registered in the class and will receive a confirmation email with details. Please click submit below.
A copy of your responses will be emailed to the address you provided.
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