Mujeres Unidas Avanzando: Student Registration Form for ESOL (English) Classes
Our classes are from September to June. We accept new students at the beginning of each month if there is space available.

Please answer all questions as completely as possible.

This application is only for our English (ESOL) classes. If you are interested in our Computer Trainings, our HiSET (GED) Preparation classes or our job trainings (Home Health Aide, Clinical Medical Assistant, or Phlebotomy), you will find those applications at www.muaboston.org. Thank you!
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Email *
Today's Date: *
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Full Name (First and Last): *
Which class schedule works best for you? Please select all that are possible. *
Required
Is this your first time studying at MUA? *
If you answered "no" in the previous question, when was the last time you studied at MUA, and in which class?
How did you learn about MUA? Please check all that apply. *
Required
Were you referred to MUA by another organization? If yes, which organization? (For example: DTA, MassHire, a shelter)
Date of Birth: *
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Sex: *
Preferred pronouns: *
Address (Street): *
Address (City): *
Address (Zip Code): *
Phone Number: *
Email Address: *
Are you Hispanic or Latino? *
Race (Check all that apply): *
Required
Country of Birth: *
Languages Spoken: *
Highest Level of School Completed: *
Where did you receive your highest level of education? *
Have you ever been enrolled in public education in Massachusetts (K-12, community college, other adult education program? *
Current Employment Status: *
What are your barriers to employment?  **Check all that apply.
Do you receive any of these forms of Public Assistance?  **Check all that apply,
Emergency Contact (Name): *
Emergency Contact (Phone Number): *
What is your emergency contact's relation to you? (Husband, mother, friend, cousin, etc.) *
Disability Disclosure
This Adult Education Program does not discriminate on the basis of disabilities. Applicants may but do not have to disclose disabilities. Applicants who do disclose disabilities may be entitled to reasonable accommodations.
Do you understand that you are not required to disclose any disabilities? *
Do you wish to disclose a disability?
Do you understand that disclosing this disability may make you eligible for reasonable accommodation?
Clear selection
Do you wish to request any specific accommodations at this time?
Clear selection
Is the documentation of your disability up to date?
Clear selection
Volunteer Work
Some students at MUA serve in the school as volunteers in many different ways, in addition to taking classes. If you would like to participate as a volunteer, please complete the following question.
Are you interested in learning more about how to volunteer at MUA? *
Donation
All classes and services are free, but we do accept donations from students who are willing and able to contribute. If you are interested in making a donation, you can do so at: https://muaboston.org/support-mua/ through Paypal. A donation is not mandatory, and students can still participate in the program if they are unable to make a donation. Thank you in advance!
Massachusetts Department of Education and Secondary Education, Adult and Community Learning Services: Release of Information Form
Dear Student: The Massachusetts Department of Elementary and Secondary Education (DESE) funds Mujeres Unidas Avanzando and almost 100 others like it. In order to continue to support these programs, DESE must report information about students, including student outcomes, to the federal government. After students leave their program, DESE collects information about their outcomes by matching their personal information with Department of Unemployment Assistance employment data, with GED and HiSET high school equivalency (HSE) test results, and with National Student Clearing House and Department of Higher Education postsecondary enrollment records. DESE combines the data sets and reports them to the federal government. If you sign this Release of Information form, DESE will also share your employment data, HSE test results, and postsecondary enrollment information with your program, Mujeres Unidas Avanzando, so it can understand how well it is helping students. DESE and your AE program will not disclose this confidential information under any other circumstances unless required to do so by law. Thank you. *
Required
Please type your full name. This will serve as your electronic signature and demonstrates that you understand the terms and conditions of registering for classes at MUA. *
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