Student Application Name* First Last Date* MM slash DD slash YYYY Email Enter Email Confirm Email Phone where we can contact you:* Can we text you?* Yes No Date of Birth MM slash DD slash YYYY Gender Marital Status* Married Not Married If you are married, does your spouse support your literacy goals.* Yes No Work and EducationThis will help us place you and schedule your tutoring sessionsWork History - Are you currently working and where? Are you on Public Assistance?* Yes No Can you read? Do you speak any languages besides English? Highest Education Level completed Elementary Middle School High School Choose 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 someone Flyer or Handout Facebook Δ
