Student Registration Form

 

 

 

 

(Please Please provide all information requested:

DATE: 

NAME:

Mr. or Ms.   

First:    Last:     Nickname:

ADDRESS:

Street:            Apt. #:       

    City:             State: District of Columbia Maryland Virginia (select from list...)       Zip Code:         

E-mail:

Home Phone:    Work Phone:   

OTHER:

Current Occupation:

Home Country:

What was your profession in your home country?

How long have you lived in the United States?

What languages do you speak?

How did you learn about People Without Borders?

What classes have you taken with People Without Borders?

What computer programs have you used?

What class would you like to register for?

EXPERIENCE:

What is your conversational English level?     

Beginning  Intermediate  Advanced

When do you use a computer?

At home   At work  Never

Do you own a computer at home?

Yes   No

Do you know how to type?

No   Yes, but not using correct fingers   Yes, I type quickly