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Registration Form for ELL Center Classes
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* Indicates required question
Email
*
Your email
Name (First and Last)
*
Your answer
Address
*
Your answer
Phone #
*
Your answer
Emergency Contact Full name
*
Your answer
Emergency Contact phone #
*
Your answer
Country of Origin (native country)
*
Your answer
Native language (Home language)
*
Your answer
How many of your children go to school?
*
1
2
3
4
5
6
7
Required
Schools my children attend
*
Preschool at ECC D68
Pre-K at ECC D68
Devonshire
Highland
Stenson
Fairview
East Prairie
Meyer
Middleton
McCracken
Old Orchard Junior High
Niles West
Niles North
YWCA referral
Required
Please register me for (Check each class that you want to register for. You can register for more than one class)
*
ESL0
ESL0AFG
ESL1
ESL2
ESL3
ESLREAD
COMP1
COMP2
COMP3
CTZN
Required
I need childcare for this class
*
Yes
No
Maybe
I need transportation to get to this class
*
Yes
No
Maybe
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