Conversations That Matter



Download 13.65 Kb.
Date09.06.2018
Size13.65 Kb.
The jefferson Clemente

Course in the Humanities
Application for 2018 Clemente Course: “Conversations That Matter”
March 19 - May 30, 2018

Mon/Wed, 6-8:30 PM

Pope Marine Building, Port Townsend WA


to apply: 1) Email: jeffcoclemente@gmail.com, or call/text Arendt Speser (360-774-6635)
2) fill out this application completely and bring it with you to the interview

Name ______________________________


Address ______________________________________ City _______________State ______ Zip ___________
Home phone ____________________ Other phone___________________
Marital status: ___Single ___ Married ___Separated ___Divorced ___Widowed

Do you have children? ______ If so, how many? ______ Age(s) _____ _____ _____ _____ _____

Would you need childcare to attend classes? _______ Would you need help with transportation? _________
If yes, what kind of help? Bus fare?____ Carpool? ______ Other?____
What is your primary language? English?______ Other? _______________
Ethnicity (Optional): ___White ___ African American ___Latino ___ American Indian ___Asian ___Other

If Other, please identify ___________________________________________


Education: Highest grade completed_______ Are you currently in school?______
If so, which school? ____________________________ If not, are you a HS graduate? ____________
G.E.D. recipient? __________ Working on your G.E.D.?_________
Have you ever attended college?____ If so, when? For how long? ____Which college? _____________
Why did you stop? ________________________________________________________________
Employment/training: Skill/Occupation ____________________________________________

___ Employed full-time ___ Employed part-time ___Unemployed ___Volunteer ___ Interning

Entitlements (such as TANF, SSI, etc) ________________________

Enrolled in other programs (school, recovery, etc.): Yes____ No _____

Names of Programs (Optional)_______________

U.S. Citizen?______ Permanent resident?_______ If not, where were you born?________________


On A separate sheet of paper, please write About yourself, your interests, and why you want to attend THE CLEMENTE COURSE.
Thank you. We look forward to hearing from you soon!

Download 13.65 Kb.

Share with your friends:




The database is protected by copyright ©ininet.org 2020
send message

    Main page