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Your name / Su nombre

Last name / Apellidos *

First Name / Primer Nombre *

Middle Name / Segundo Nombre

Pronoun / Pronombre

Contact / Contacto

Address / Dirección

City / Ciudad

State / Estado

Zip Code / Código Postal

County / Condado

Phone Number / Número de Teléfono

Can we text you? / ¿Podemos enviarle un texto?

Yes No

Email / Correo Electrónico

About you / Sobre usted

Date of Birth / Fecha de Nacimiento (MM/DD/YYYY) *

Gender / Género *

Country of Birth / País de Nacimiento

Native language / Idioma Natal

Hispanic / Hispano

Yes No

Race / Raza *

Work and schooling / Trabajo y estudios

Employment Status / Situación de trabajo *

Public Assistance / Asistencia pública *

Highest Formal Education Level / Nivel de Educación Formal Superior *

Education Location / Ubicación de educación *

Please check all that apply / Marque todo lo que corresponda

Disability / Discapacidad Learning Disabled / Discapacidad de aprendizaje Displaced Homemaker / Ama de casa Ex-Offender / Ex criminal Migrant Worker / Trabajador inmigrante Foster Care / Acogido Single Parent / Padre o madre soltero Homeless / Sin hogar Came to U.S. as Refugee / Refugiado Have school-aged children at home

Household and emergency contact / Hogar y contacto de emergencia

Emergency Contact Name / Contacto de Emergencia Nombre

Emergency Contact Telephone / Contacto de Emergencia Teléfono

Yearly Income / Salario anual

Number of People Supported in Household / Número de personas que dependen de usted

How Did You Hear About This School? / Dónde escuchó de esta escuela

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Come to 2315 Chicago Avenue during school hours and we will help you. Or call 612.874.9963. Assistance in Somali is available by phone.

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Main Office2315 Chicago Avenue, Minneapolis, MN 55404
Call: 612.871.5900 · Fax: 612.871.0017
communications@oscs-mn.org

Our Saviour's Housing2219 Chicago Avenue, Minneapolis, MN 55404
Call: 612.872.4193 · Fax: 612.872.4442
communications@oscs-mn.org

English Learning Center2315 Chicago Avenue, Minneapolis, MN 55404
Call: 612.874.9963 · Fax: 612.871.0017
info@englishlc.org

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