form ESOL

Section I: Personal information

First name

Last name

Gender

Birthday

Nationality

Address

City

County

State

Zip code

Country

Phone number

Email

Questionnaire

1- Do you own a computer?

Yes

No

2- What country are you from?

3- What languages do you speak?

4- When did you come to the United States?

5- Did you go to school in your country?

6- Have you studied english before?

7- How many children under 18 in U.S.?

8- Do you have a job?

9- Are you looking for a job?

10- Have you been vaccinated for COVID-19?

Yes

No

Section II: Emergency contact

Contact full name

Relationship

Phone number

Alt. phone (optional)

Contact email

Contact address

Please provide someone we can reach immediately in case of an emergency during school hours.

Section III: English level

Please answer these questions in English to help us determine your placement level.

1. What is your full name? (Please type it as you did in section I)

2. Where are you from and what is your native language?

3. How long have you been living in the United States?

4. Describe your previous experience studying English.

5. What are your main goals for learning English? (Work, University, Daily life?)

4

Section IV: ID Documents

Identification number (Passport / National ID)

Upload Identity Documents

Up to 5 files (JPG, PNG, PDF).
Max size: 900 KB per file.

Section V: Identity Photo

Official Preview (3:4)

Your passport photo will appear here

Resolution: 600x800px (ID Standard)

Section VI: Terms & conditions

1. Accuracy of information

I certify that the information provided in this enrollment form is true and correct to the best of my knowledge. I understand that any false statements may result in the cancellation of my enrollment.

2. Privacy policy

The school collects personal information for registration purposes only. Your data, including the photo captured in step 5, will be stored securely in our database and will not be shared with third parties without your consent.

3. Attendance & participation

By enrolling, I agree to follow the school's code of conduct and maintain a consistent attendance record as required by the program to ensure my academic progress.

4. Media release

I understand that photos or videos taken during school activities may be used for educational or promotional purposes unless I submit a written request to opt-out.

I have read and agree to the terms & conditions.

Electronic signature

Please type your full name below to sign this document electronically.

Date: 01/06/2026

Final confirmation

By clicking "Finish & generate PDF", you are officially submitting your application. You will not be able to edit your information after this step.

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