One-to-One Learner Form

If you wish to participate in the One-to-One Adult Literacy Partners program, fill out the form below to register as a learner. The One-to-One Coordinator will process the information and work to match you with a suitable tutor.

Applicant Information

First Name

Middle Initial

Last Name

Date of Birth

Gender

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Employment Status

Employer

Job Title

Including yourself, how many adults live in your household?

How many children live in your household?

Ethnic Background

What is your birth country?

Native Language

Other Spoken Language(s)

Language Spoken at Home

Would you describe yourself as Hispanic or Latino?

If not Hispanic or Latino, select the background that best describes you

Education

In what country did you attend school?

Highest grade or level attended

Have you enrolled in English language learning in the past?

When did you study English?

Where did you study English?

How long did you study English?

Have you ever attended LTC (Lakeshore Technical College)?

What year(s) did you study there?

Literacy Tutoring

List the days and times you're available for tutoring

Select whether you have a preference for a male or female tutor

Female tutor

Male tutor

No preference

What is your first goal with your tutor?

How did you hear about One-to-One Adult Literacy Partners?

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