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Art Class Registration Form
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Which class are you taking?
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First Name
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Last Name
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Are you a People's Resource Center Client?
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Yes
No
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If yes, what is your PRC Client ID Number?
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How did you find out about our virtual art classes?
Word of mouth
Other PRC program/service
PRC website
Facebook
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Other:
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What is your date of birth?
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Address
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Apartment
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City
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Zipcode
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Phone Number
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Other Phone Number
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Email address
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Gender
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What country were you born in?
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What is your first language?
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Race
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American Indian/Alaskan Native
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Pacific Islander/Native Hawaiian
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Ethnicity
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Hispanic
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Highest Level of Education
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0-8 Years
9-12 Years
High School Graduate
12+ Years
College Graduate
Income Sources (check all that apply)
Employment
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Social Security-Retirement
TANF
Child Support
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Employment Status
I work full-time
I work part-time
I am looking for a job
I am not working
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Approximate Total Monthly Household Income
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