English Class Student Registration Form

Please fill out this form to register for English classes

English for Work Student Registration Form

Please complete this form to register for English classes.

"*" indicates required fields

Name

This field is for validation purposes and should be left unchanged.

Student Information

First Name*

Middle Name

Last Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Date of Birth*

Month

Day

Year

Gender*

Male	Female	Other Identity

Contact Information

Phone*

Email Address*

Enter Email Confirm Email

How do you prefer to be contacted?*

Text

Call

*By providing a telephone number and submitting this form you are consenting to be contacted by the International Institute of Minnesota via text message (SMS and MMS) with Institute updates and information. Message frequency may vary. Message & data rates may apply. You can opt-out of messaging by replying STOP and get more help by replying HELP. View our Privacy Policy and Terms of Service

Is it okay if the International Institute of Minnesota texts you?*

Yes, it is okay if the International Institute of Minnesota texts me.

No, it is not okay if the International Institute of Minnesota texts me.

Emergency Contact

Name*

Phone*

Relationship to you:*

Class Preference & Resource Help

I want classes:*

In-person

Online

I want class time:*

Morning

Afternoon

Evening

I want information to (Choose all that apply):

Student Questionnaire

How did you hear about us?*

Current Institute student

Friend

Case manager

Google

Social media (Facebook, Instagram)

Saw the building

Other

Why do you want to register for English class?*

People use English in Minnesota

To get my GED

To go to college or university

To get a job

To get U.S. citizenship

Other

Student Demographics

Country of birth:*

Primary language(s):

Date of U.S. arrival*

Month

Day

Year

Ethnicity:*

Are you Hispanic?*

Yes

Race:*

American Indian/Alaskan Native

Asian

Black/African American

Native Hawaiian/Other Pacific Islander

Multi-racial

White/Caucasian

Education level:*

No schooling

Grades 1-5

Grades 6-8

Grades 9-12 (no diploma)

Secondary school diploma/alternate credential

Secondary school equivalent (GED/HISET)

Some college/university (no degree)

Graduated from college/university

Education location:

In the United States

Not in the United States

Work status:*

Employed

Employed, to be terminated/separated

Not in labor force

Unemployed

Public Assistance Information

Are you receiving help from the government?*

Tennessen Warning / Privacy Notice

Please read the Tennessen Warning below BEFORE entering your name and date and clicking ‘Submit’

Name*

This is an electronic signature acknowledging you have read and understand the Tennessen Warning/Privacy Notice.

Today's Date*

Month

Day

Year

Please read this BEFORE signing your name above and submitting your form!

Tennessen Warning / Privacy Notice

This form tells you how we may use the information from your application and participation in this program. It also says who we may tell this information to, and what will happen if you choose not to provide it.

Why do we ask you for program information?

We may ask you for information so we can:

tell you from other persons with a similar name
decide if you can receive our services
decide which services you can receive
receive state and federal funds to help you
let program funders know if Adult Basic Education has helped you

You are not required by law to provide this information. If you choose not to provide this information, we may not know whether you are eligible for the program and may not be able to help you. Providing false information can lead to removal from the program.

How will we use the data?

We may use it to prepare required reports, conduct audits, review eligibility and to find out how the program is helping you.

Who will we share the information with?

We will share the information with staff, allowed by law, who need it to do their jobs in: The MN Dept. of Jobs & Training; U.S. Depts. of Health & Human Services, Labor, Housing & Urban Development, and Agriculture; and software developer UrbanPlanet Software. We may share it with community-based agencies, local and state human service agencies, educational programs, and other agencies that help you. If you enroll in another MN Adult Basic Education program, your data will be shared with them.

Social Security Numbers

You do not have to provide your Social Security number. Federal Privacy Act and Freedom of Information Act dictate the use of this number. We may use it for computer matches, program reviews, improvements, and audits.

How long will we keep the information?

After you leave the program, we will keep your file until state and federal laws let us destroy it.

If you do not understand this form, ask a staff person to explain it to you.

Register for Classes

In-person classes require in-person registration at a Friday intake. The following classes are in-person (English classes have online options. Click ‘Get Started’ below to register for an online English class):

Citizenship Classes
Driver’s Education
Community Workshops
English (online option)
Housekeeping Training
Dietary Aide Training

When:

Every Friday

Arrive between 11 a.m. – 12 p.m. (Get directions.)

Please plan to be here for at least two hours, depending on how many students are waiting. During your visit, you will take an English test and talk about your goals. Our teachers will help you start the best class for your learning level.

For all other questions about classes and programs, please contact us using the form below.

Contact Us

Please contact us with any questions you have about English classes at the International Institute of Minnesota.

Espoir Katengura
Student Services Assistant
(651) 377-8670

Email Espoir