Student Application Name* First Last Date* Date Format: MM slash DD slash YYYY Email Enter Email Confirm Email Phone where we can contact you:*Can we text you?*YesNoDate of Birth Date Format: MM slash DD slash YYYY GenderMarital Status*MarriedNot MarriedIf you are married, does your spouse support your literacy goals.*YesNoWork and EducationThis will help us place you and schedule your tutoring sessionsWork History - Are you currently working and where?Are you on Public Assistance?*YesNoCan you read?Do you speak any languages besides English?Highest Education Level completedElementaryMiddle SchoolHigh SchoolChoose Preferred Day of Week for ClassesSundayMondayTuesdayWednesdayThursdayFridaySaturdayChoose Best Time for ClassesMorningAfternoonEveningDo you have transportation?Tell us about your literacy goals and related information you'd like to shareHow Did you learn about the Literacy Council?Told about it by someoneFlyer or HandoutFacebook
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