Request for Information Form

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Please note the following when leaving your information:

~Make sure that the cell phone number you enter does not block texting as we often communicate with our students in this way.

~Please make sure that the email address you enter is one that you are able to check often so that you don't miss important communication.

~Please be careful that you enter your name correctly as your FIRST NAME and LAST NAME. This is how your name will appear for us in our communication system.

Email *

First Name *

Last Name *

Street Address *

City, State, Zip Code *

Phone number *

Are you 18 years old or older? *

Yes

Which class(es) are you interested in? *

Adult Basic Education (improve basic skills)

High School Equivalency Preparation

English Language Acquisition

Career Certification Training

Other:

Required

Which do you prefer?

On-site classes

Online classes

Both on-site and online classes

What time of day do you prefer for on-site classes?

Morning

Evening

What time of day do you prefer for online classes?

Morning

Evening

What is the most convenient time to contact you?

Morning

Evening

Is there any additional information you would like us to know?

Send me a copy of my responses.

Submit

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