APPLICATION

Full Name (required):

Address

Apt. / P.O. Box

City

State

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.

 

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By clicking the "Apply" button below, I confirm that I will attend class regularly, participate in discussions, and complete all readings and assignments.