ESL Registration

For students 18 years of age and older, we provide free English as a Second Language (ESL) services for residents of the following counties in Nebraska and Iowa.

Nebraska

Burt County
Cass County
Dodge County
Douglas County
Sarpy County
Saunders County
Washington County

Iowa

Harrison County
Mills County
Pottawattamie County

Please review the terms and conditions.

https://app.termly.io/document/privacy-policy/569a2a38-b74c-4a65-acf8-94b804e958cd

Program of Interest *

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What county do you live in? *

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First Name *

Last Name *

Email *

Phone 1 *

Do you use WhatsApp? *

If you use WhatsApp, please leave us your WhatsApp phone number.

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Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code

Birthday *

Gender *

Race/Ethnicity *

American Indian/Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

White/Caucasian

Two or More Races/Other

Prefer not to answer

Country of Origin *

Primary First Language *

If your primary first language was not listed, please enter it here.

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Are you a returning student? *

Have you attended any schooling in the United States? *

In your home country, what is the highest degree or level of school completed? *

Annual Household Income *

Employment Status *

Participant Status *

Dislocated Worker

Displaced Homemaker

Learning Disabled Adult

Low Income

Single Parent

None of the Above

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Do you have a learning disability? (Please select all that apply.)

ADHD

ADD

Dyslexia

Difficulty Concentrating/Easily Distracted

Memory problems/Struggles to retain information

Vision/Visually impaired

Other

I don't know/Unsure

No, I do not have a learning disability

Have you used Zoom?

Have you taken an online class?

Are you interested in Distance Learning, taking classes online with a live instructor?

Do you have any roadblocks to completing your goals at Learning for ALL?

What are your specific goals?

Please write about your education journey:

What are your strengths?

What are your weaknesses?

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Emergency Contact: First Name

Emergency Contact: Last Name

Emergency Contact: Phone Number

Emergency Contact: Relationship

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