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Questions for Citizenship Tutoring at Rian Immigrant Center
Please answer the following questions
IN ENGLISH.
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* Indicates required question
What is your name? (Example: Maria Sanchez)
*
Your answer
What is your email address?
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Your answer
What is your phone number?
*
Your answer
What is your birthdate? (Example: October 24, 1980)
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Your answer
What is your home address?
(Street, City, Zip Code, State)
*
Your answer
How many people live in your home?
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Your answer
Do you have any children?
Yes, I do.
No, I don't.
Clear selection
Are you married?
Yes, I am.
No, I'm not.
Clear selection
What is your gender?
*
Female
Male
Other/Prefer not to say
What is your country of origin? country of origin = the country you were born in
*
Your answer
Which language(s) do you speak?
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Your answer
What is your race/ethnicity?
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White (Non-Latino)
Asian
Asian and White
Native Hawaiian/ Pacific Islander
American Indian/ Alaskan Native
Black/African American (Non-Latino)
Black/African American and White
Latino/Hispanic
Other/Multiracial
Do you have a Green Card now?
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Yes
No
No, I am in the process of getting my green card.
When did you become a legal permanent resident (green card holder)?
Answer with the month and year. (Example: April 2016)
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Your answer
What is your employment status?
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Working full time (40 hours/week)
Working part time
Not working
What is your paycheck amount for 1 month?
Answer $0.00 if you do not have a paycheck.
*
Your answer
Who told you about Citizenship tutoring at Rian Immigrant Center?
*
A different program at Rian Immigrant Center
JVS
Project Citizenship
Department of Children and Families (DCF)
Family
A friend
A coworker
Other
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