State
Number of chidren
Date of birth
Country of Birth
How long have you lived in Manatee County?
Employer
Adress of Employment
Have you ever been convicted of a felony? if yes, Explain
Profession:
Have you contacted us before or been in our Literacy Program?
Do you have transportation?
Are you near public transportation?
Do you live near one of the public libraries?
Sex
Employer status
Ethnic Group
Do you have any known disabilities?
Can you read English?
Can you write English?
Education
Can you afford to buy your own books?
How did you hear about our training program?
Do you have problems seeing or hearing? Be specific.
Preferred day for training or tutoring
Preferred Library location:
To save mailing costs, we communicate electronically. May we use your email for communication? it will NEVER be shared or sold.
Thank you for your interest Manatee Literacy Council. The form has been submitted! We will contact you soon.
Michelle McLean
Executive Director