Adult Education Registration Form (FY27)

Thank you for your interest in Adult Education classes at Trellus!

Steps to enroll in a class at Trellus:

Complete the following Registration Form
If you are a new student, you will need to come to Trellus (2838 W. Peterson Ave.) to complete your English speaking, writing, and reading tests during our scheduled Registration Days. The testing will take around 2-3 hours to complete. If you have not received the Registration Day information (date/time), please text (773) 293-8457 or email adulted@mytrellus.org.

**Please Note: We will not offer the following courses during the Summer 2026 term:

Evening Online English classes, Healthcare English (ESL), Education Careers, Paraprofessional Educator ICAPS

Summer term dates:

- July 13 - August 20

If you have any questions, please email adulted@mytrellus.org. Thank you!

Please type your answers in English.

Пожалуйста, пишите свои ответы на английском языке.

Por favor conteste en inglés

الرجاء كتابة الإجابات باللغة الإنجليزية

Which class are you interested in....?

First Name

Last Name

Date of Birth

Review your Date of Birth here.

Do you have any children?

YesNo

If yes, what are their ages?

Are you a CPS (Chicago Public Schools) Parent?

YesNo

Do you have a Social Security Number?

YesNo

Please provide your Social Security Number

Country of Origin (Home Country)

Native language (first language)-may be more than 1

Are you Hispanic or Latino? (Are you of Spanish origin?)

YesNo

Contact Information

Must live in Chicago or the neighboring suburbs

Mailing Street

City

State

Zip Code

Phone Number

Email Address

Emergency Contact

Name of Emergency Contact and Relationship (Example: David Smith - husband)

Phone Number of Emergency Contact

Education

Did you attend school in the past?

Yes, NOT in the U.S.Yes, in the U.S.No

Number of school years completed (check one)

Do you have a GED or HS diploma from the United States?

YesNo

Do you work?

Not WorkingWorking Full TimeWorking Part TimeEmployed, received notice of termination or Military Separation

What is your occupation (or job) if you are working?

If you are working, who is your employer? (Example: Avamere, McDonald's, Hilton Hotels...)

If you are employed, how many hours do you work per week?

What is your monthly income?

Other

Disability?

YesNoI don't want to say

Disability Description

If "Family/Friend", please provide the name:

Do you receive Public Assistance (like government health care, food stamps/link card....)?

YesNoI'm not sure

Do you have internet access at home?

YesNo

What devices that connect to the internet do you have at home?

Desktop computerLaptopTabletSmartphone

Goals

All students must choose a career pathway to learn more about in their English studies or explore in the future.

Choose 1 or 2 areas that you want to learn more about

Choice 1 from the picture above that you want to learn more about

Choice 2 from the picture above that you want to learn more about (not required)

Final Questions

Do you have any questions or comments?

By signing this registration form, I agree to the attendance policy and rules of the Trellus Adult Education Program. Please type your name below for a signature.

Trellus Adult Education