Literacy First Registration Form

Please use this form to enroll students in Literacy First classes. You must complete all sections of the enrollment form to ensure enrollment in the class of your choice.

 

 

 

 

 

Course #*:          Location*:         

Dates*: 

Name*:         

Social Security Number*: 

Grade/Subject*:         

Highest Degree Attained*: 

Home Address*:         

Home City*: 

Home State*:          Home Zip*: 

Home Phone*:         

School Phone*: 

E-mail Address*:   

School Name*: 

School Address*:         

School City*: 

School Zip*: 

Principal*:         

School District*: 

School District Address*:         

School District City*: 

School District Zip*: 

Superintendent*:         

County*: 

Thank you for submitting the following information.  You will receive a confirmation letter from us 2-3 weeks prior to the class starting.  If we can not get you enrolled in the class requested, we will call or email you to let you know the situation.  If you have questions or concerns please contact Jim Vercelli or Amy Eckart-Gregg.  Thank you for registering online for Literacy First.