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BCYF Blackstone Community Center
Application for Parent English Classes (Please note: Classes will be remote and in-person this year.)
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Date
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MM
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DD
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YYYY
First Name
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Your answer
Last Name
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Your answer
Street
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Your answer
City
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Your answer
Zip Code
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Your answer
Date of Birth
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MM
/
DD
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YYYY
Gender
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Female
Male
Non-Binary
Other:
Phone Number
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Your answer
Email Address
Your answer
Where are you from?
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Your answer
What year did you come to the United States?
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Your answer
What is your first language?
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Your answer
Last grade in school completed in your country?
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Your answer
Check the level that is you?
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1 Beginner (no English)
2 Intermediate (some English)
3 Advanced (fluent but need writing and reading )
What is your occupation?
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Your answer
Do you work full time or part time?
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Full time
Part time
I don't work
How many children do you have?
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Your answer
How many children go to school in Boston?
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Your answer
What are the names of the schools your children attend?
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Your answer
Year of Birth Child #1
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Your answer
Year of Birth Child #2
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Your answer
Year of Birth Child #3
*
Your answer
Year of Birth Child #4
*
Your answer
Class days are Tuesday, 9:30am - 12:30pm (online) AND Saturday, 9:30am - 12:30pm (in person).
Do you need child care for the Saturday (9:30am-12:30pm) in-person class?
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Yes
No
Comments or questions
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