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FY21 MMALC Spring Inquiry Form
Welcome to Mid-Manhattan Adult Learning Center!!
Please complete the form and a Case Manager will be in contact with you.
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* Indicates required question
Last Name (s)
*
Your answer
First Name (s)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Choose
Female
Male
Other
Race/Ethnic Identity
*
Choose
Native Hawaiian
Native American
Alaskan Native
Asian
Pacific Islander
African American
Afro-Caribbean
African
Latino/a
White (not Latino/a)
Employment Status
*
Choose
Employed Full Time
Employed Part Time
Employed but Received Notice of Termination
Military Separation Pending
Unemployed & Seeking Employment
Not Available for Employment
Inmate
Did you attend a Summer Class from 7/6/20 to 8/14/20?
*
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Yes
No
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