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FAS - Online Registration Application

Please complete the registration form below. Required fields marked with an asterisk *

Contact Information

First Name*

Primer Nombre

Answer Required

Middle Name

Segundo Nombre

Answer Required

Last Name*

Apellido

Answer Required

Email Address

Correo Electronico

Answer Required

Contact Phone*

Número de teléfono

Answer Required

Alternative Phone

Número de teléfono alternativo

Answer Required

Emergency Contact Information (Contacto de emergencia)

Name*

Contacto de Emergencia

Answer Required

Relationship*

Relación con usted

Answer Required

Phone*

Número de teléfono

Answer Required

Student Information

Birthdate *

Fecha De Nacimento

Answer Required

Gender*

Género

Answer Required

Male (Masculino)

Female (Mujer)

Other (Otro)

Racial Group (Grupo Ethnico)*

Mark one or more

Answer Required

Hispanic ( Hispano)

White (Blanco)

Black or African American (Afro Americano)

Asian (Asiático)

Pacific Islander (Isleño del Pacífico)

Filipino

Native American (Nativo Americano)

Other:

Native Language*

Primer Idioma

Answer Required

Employment Status*

Trabajo

Answer Required

Education Experience *

Experiencia Educativa

Answer Required

Family Status (Estado Familiar)*

Select all that apply (Seleccione todos los que correspondan)

Answer Required

No Children (Sin niños)

Child/Children at Home (Niño/Niños en casa)

Child/Children in school (K-12) (Niño/Niños en la escuela K-12)

Other:

Family Income Level (Nivel de Ingreso Familiar)*

Total yearly income (Ingresos Totales Anuales)

Answer Required

Reason for Enrollment (Motivo De Inscripción)*

Mark all that apply (Marque todo lo que corresponda)

Answer Required

Improve skills (Mejorar mis habilidades)

Get a job (Conseguir un trabajo)

Improve job (Mejorar mi trabajo)

Personal goal (Objetivo personal)

Family goal (Objetivo familiar)

Mandated (Mandato)

Military (Militar)

Enter Post-secondary Ed. (Entrar a la universidad)

Other:

Special Status (Estado Especial)

Mark all that apply (Marque todo lo que corresponda)

Answer Required

CalWORKS

WIOA

Dislocated Worker (Trabajador dislocado)

Single Parent (Padre soltero)

Rehabilitation (Rehabilitación)

Veteran (Veterano)

Disabled (Deshabilitado)

Displaced Homemaker (Ama de casa desplazada)

Financial Aid (Ayuda financiera)

Other public assistance (Otras ayudas públicas)

Other:

How did you hear about our program?*

¿Cómo se enteró de nuestro programa?

Answer Required

Program Student (Estudiante del Programa)

Flyer (Folleto)

Word of Mouth (Alguien me dijo)

Website (Sitio)

Other:

Fillmore Adult School - Semester 1 Class Schedule

Course	Room	Time	Days	Teacher
Adult Basic Education (ABE) Instruction (speaking, reading, writing) for pre-ESL & pre-literate students	Sierra High, Room 2	6 – 8 pm	Mon – Thurs	Marlene Carvajal
English as a Second Language (ESL) Level 1 Beginner	Sierra High, Room 6	6 – 8 pm	Mon – Thurs	Bobby Martinez
English as a Second Language (ESL) Level 2 Intermediate	Sierra High, Room 5	6 - 8 pm	Mon - Thurs	Grecia Garcia
English as a Second Language (ESL) Level 3 Advanced	Sierra High, Room 1	6 - 8 pm	Mon - Thurs	Unfilled
English as a Second Language (ESL) Multiple Levels AM	District Office, Room 34	9 – 11 am	Mon - Thurs	Bobby Martinez
Adult Secondary Education (ABE) Instruction (speaking, reading, writing) for post-ESL students	District Office, Room 34	6 – 8 pm	Mon - Thurs	Maria Mungia-Wellman
ESL and Civics for U.S. Citizenship A Prepare for US Citizenship Exam	Rancho Sespe Apts., Piru	6 – 8 pm	Tues & Thurs	Ray Barerra
ESL and Civics for U.S. Citizenship B Prepare for US Citizenship Exam	District Office, Room 34	6 – 8 pm	Mon & Wed	Maria Meza
VESL Auto Mechanics Learn English and basic auto mechanics and maintenance	Fillmore High, Room 8	5:30 – 8:30 pm	Mon & Wed	Adan Vega
Computer/Internet Basics Level 1 For novice users	Fillmore Active, Adult Center	9 – 11 am	Tues & Thurs	Marlene Carvajal
Computer/Internet Level 2 Intermediate level. Must have completed Level 1	District Office, Room 36	9 – 11 am	Mon & Wed	Marlene Carvajal
VESL Beginning Computer Technology Learn English and basic hardware, internet and software programs	Fillmore High School, Room 53	6 – 8 pm	Mon-Wed	Lorenzo Manzano
Microsoft Certification Program Earn official MOS certifications of the Microsoft Office Suite (Word, Excel, Outlook, PowerPoint, Acces)	District Office, Room 13	6 – 8 pm	Tues & Thur	Jarom Demke
High School Diploma & Equivalency (HSE/HSD) Complete units for diploma and prepare for HiSET	District Office, Room 35	5 – 8 pm	Mon - Thur	Sara Martinez
High School Equivalency in Spanish Prepare for the Spanish version of HiSET	District Office, Room 35	9 - 12 pm	Mon/Wed/Fri	Sara Martinez
Fillmore College CenterDrop-in math tutoring and college/career counseling	District Office, Room 36	5 – 6 pm	Mon - Thurs	Maria Mungia-Wellman

Depending on availability, once you complete the registration process you will be enrolled in the class based on your selection below.*

Dependiendo de la disponibilidad, una vez que complete el proceso de registro, se inscribirá en la clase de su selección a continuación.

Answer Required