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Citizenship Program Application Form
Spring 2021 / Online classes
All information provided on this form is confidential and is used by staff only.
* Indicates required question
Email
*
Your email
Applicant's Full Name
*
Your answer
Date of birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Transgender
Other
Country of Origin
*
Your answer
How many years have you been a legal permanent resident of the United States?
*
Your answer
Write your Alien Number (USCIS A-Number)
*
Your answer
Have you sent your application for citizenship?
*
Yes
No
If yes, when did you send your application?
MM
/
DD
/
YYYY
Current address
*
Your answer
Email address
*
Your answer
Telephone number
*
Your answer
Write the full name of an emergency contact
*
Your answer
Emergency contact phone number
*
Your answer
Highest level of education completed
*
Elementary School
Middle School
High School
College
Master
Other:
Are you currently working?
*
Yes
No
Required
If you are currently working, how many hours a week do you work?
*
Your answer
Can you afford the class fee of $30?
*
Yes
No
Required
Have you taken classes at Manos de Cristo before?
*
Yes
No
If yes, which classes have you taken?
English as a Second Language (ESL)
Computer
Plazas Comunitarias
Citizenship
Do you have internet access in your home?
*
Yes
No
Other:
Do you own a computer?
*
Yes
No
Do you have experience using any of the following:
*
Email (examples: Gmail, Hotmail, Yahoo, etc.)
Google Meet
Google Classroom
Zoom
Required
Are you interested in purchasing a low-cost computer or Wifi hotspot?
*
Yes
No
Maybe
Other:
Choose your preferred schedule: (we cannot guarantee that your preferred schedule is available)
9:00 AM - 12:00 PM
6:00 PM - 9:00 PM
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