EmailMe Form - Adult Education and Literacy Program PY23-24

Name

First Last

Email

Phone

### - ### - ####

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Adult Education and Literacy Programs that are recipients of federal dollars are required by the Federal government to solicit certain demographic information to meet federal reporting requirements. Applications are requested to provide the following information voluntarily. This information will not be utilized in a discriminatory manner.

Race / National Origin

Native Language

Gender

Male

Female

Date of Birth

MM / DD / YYYY

Which Program of Study are you interested in?

English Language Learner

High School Equivalency Prep

Workkeys Prep

Academic assistance- reading, math or language

What is your profession?

Which class time are you interested in attending?

Completion of the Pre-Registration form does not guarantee placement in our free classes. Anyone entering a class must be assessed prior to beginning class. Form must be completed and submitted prior to the scheduling of your assessment. Someone will contact you after receipt of your pre-registration form to let you know your next steps. New Program enrollments started in late August 2023.

Are you currently over the age of 17, not enrolled in high school or holding an F1 (Student) Visa?

Yes

No

If no, please indicate the best time to for us contact you, along with your contact information to schedule your intake and pre-assessment testing.

Enter questions or comments here or call us at (314) 290-4052/ text (314) 391-9232, or email us at aelinfo@ucityschhols.org

How did you hear about our Program?: