Unidad Cultural

Computer Class Registration

Teacher ______________________

Level       ______________________

 

Student Information

 

Name ______________ Middle Initial_____ Last Name__________________  Age____ Male/Female______

 

Address __________________________________________Apt#___________

 

City____________________________ Estate_________ Zip _______________

 

Phone #(daytime)(         ) ______ ______ Business # (         )_____ ______

 

Describe the work that you do?  _____________________________________________________________

 

Do you own a computer (yes/no)? ________ If no, do you have access to a computer (yes/no)?  ________

 

Are you planning to buy a computer soon? (yes/no)? ________

 

How do you think this computer class will help you? (Please explain)