Community Learning Center Form
RequiredRequired Question(s)
Please, complete the form below and someone from Community Learning Center will contact you about upcoming classes. 
 
Required 1.
Please fill out the following information:

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com

Required 2.
What is your Zip Code?
(This will help CLC best match you with on-site classes when available)
 

50 characters left.
Required 3.
Would you like to take Adult Basic Reading, Math, or GED classes?
Yes
No
Required 4.
Would you like to take ESL (English as a Second Language) classes?
Yes
No
Required 5.
Would you like to take citizenship classes?
Yes
No
Required 6.
Are you currently a PA Careerlink Client? 
Yes, in Suburban Station
Yes, in Germantown
Yes, in West Philadelphia
Yes, in North Philadelphia
I don't know
No
7.
Do you have a high school diploma? 
Yes
No
8.
Have you taken online classes before?
Yes
No
9.
Do you have a computer, smart phone, or tablet at home?
Yes
No
10.
Do you have Wifi at home?
Yes
No