Student Registration Form / Formulario de registro de estudiante

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You will be asked to provide basic information to allow "Literacy Volunteers of Laredo" the necessary information to register you into the appropriate classes for your benefit / Se le pedirá que proporcione información básica para permitir a los "Literacy Volunteers of Laredo" la información necesaria para inscribirse en las clases apropiadas para su beneficio.

Name/Nombre *

Last Name/Apellido *

When did you submit this application? / ¿Cuándo presentó esta solicitud? *

YYYY

Gender/Género *

Male

Male/Masculino

Female/Femenino

Address/Dirección *

City/Ciudad *

Laredo

Nuevo Laredo

Other:

State/Estado *

Texas

Tamaulipas

Other:

Postal Code/ Codigo Postal *

Birth Date/Fecha De Nacimiento *

YYYY

Place of Birth/ Lugar de Nacimiento *

Laredo, Texas

Nuevo Laredo, Tamaulipas

Other:

Phone Number/Telefono *

Secondary Phone Number/Segundo Numero Telefonico *

Email Address/ Correo Electronico

Permission to Call? / ¿Esta bien si le llamamos? *

Yes/Si

Access to a Computer with Internet?/¿Tiene usted acceso al internet? *

Yes/Si

Primary Language/Idioma Principal *

English/Ingles

Spanish/Espanol

Other:

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