APPLICATION Full Name (required): Address Apt. / P.O. Box City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Email: Contact phone Date of birth Gender MaleFemale Do you have children living with you? YesNo If so, what ages? Would you need childcare in order to attend classes?YesNo OPTIONAL: What is your primary language? What is your marital status? How would you describe your ethnicity? EDUCATION: High school graduate? YesNo What year? What school? If not, are you a G.E.D. recipient? YesNo If so, when? Have you been to college? YesNo What school? EMPLOYMENT: What is your occupation or skills? Are you employed? Full-timePart-timeUnemployed If so, where? What is your approximate annual income (before taxes)? Do you receive any entitlements (such as SSI, WIC, TANF)? YesNo If so, which? WRITTEN STATEMENT: In about a page (350-500 words), write about yourself, your interests, and why you want to be part of the course. Your application will not be considered without a written statement. For security purposes, please enter the characters you see below: By clicking the "Apply" button below, I confirm that I will attend class regularly, participate in discussions, and complete all readings and assignments.