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Adult Education Citizenship Registration Form
Welcome! You are registering for a free citizenship class. Please fill out this form completely. We are excited to help you become a US Citizen! Most of the classes are in English.
Bienvenido! Se esta registrando para una clase gratuita de cuidadania. Por favor llene el formulario entero. La mayoria de las clases son en ingles. Hay una clase en espanol solo para personas que califican hacer el proceso en espanol.
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* Indicates required question
Email
*
Your email
Have you ever taken English classes with us? A tomado clases de ingles con nosotros en algun momento?
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Yes
No
I don't know
Please enter your LEGAL NAME as it appears on your state or federal id. Your first and last name. Por favor escriba su NOMBRE LEGAL como esta escrito en su identificacion.
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Your answer
Date of Birth. Fecha de nacimento.
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MM
/
DD
/
YYYY
USCIS A Number. Su numero 'A' que esta en su tarjeta de residencia
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Your answer
Your Country of Origin. Su pais de origen.
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Your answer
Your FULL Mailing address - street address, apartment number, PO Box. Direccion completa - calle, departamento, cuidad, codigo
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Your answer
Phone number. Numero de telefono.
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Your answer
Email Address. Correco electronico.
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Your answer
Social Security Number. Numero de seguro social.
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Your answer
Ethnicity. Choose ONLY one. Etnia - elija solo uno.
*
Choose
Hispanic/Latino
NOT Hispanic/Latino
Race. Please choose the best answer(s) from the choices. Su Raza - elija la mejor.
*
Choose
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
English Classes - please choose the class you would like to attend. Clases en ingles - elija la clase que quiere tomar.
*
Monday/Lunes, 6pm, El Rio Learning Center, 1390 W Speedway Blvd.
Tuesday/Martes, 6pm, El Pueblo-Liberty Center, 101 W. Irvington Rd, Building 7
VIRTUAL CLASS/CLASE VIRTUAL, Tuesday/Martes, 6pm
Wednesday/Miercoles, 4:30pm, Valencia Library, 202 W Valencia Rd
Thursday/Jueves, 4:30pm, Nanini Library, 7300 N. Shannon Road
Thursday/Jueves, 6pm, 29th St Coalition Center, 4355 E Calle Aurora, Building B
Wednesday/Miercoles and Friday/Viernes, 10:30am, El Pueblo-Liberty Center, 101 W Irvington Rd, Building 7
Friday/Viernes, 10:30am, El Rio Learning Center, 1390 W Speedway Blvd
Friday/Viernes, 1pm, 29th St Coalition Center, 4355 E Calle Aurora, Building B
Other:
Required
A copy of your responses will be emailed to the address you provided.
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