Moraine Valley Community College || Literacy || Program Application

Moraine Valley Literacy Program Application




City:      State:   Zip:

Home phone:       

Work phone:    


Date of birth:    Sex:   Male   Female

Ethnic group:
Asian  American Indian/Alaska Native  African-American  Hispanic or Latino  White  Native Hawaiian/Pacific Islander Choose not to respond

Place of employment:

Area or field of work experience (include volunteer experience):

How did you hear about the program?

Preferred activity (please check all that may apply):

Tutor: ABE/GED   ESL  Literacy  Math

Computer Lab Aide

Special skills or interests:

Do you have any teaching experience? (Include volunteer experience—church or on-the-job, etc.)

Have you studied a foreign language? (Which) 

Are you fluent in a foreign language? (Which)  

Check the highest level of education completed:

High School  GED

College Level: 1  2  3  4

Graduate Studies: Years


Major area of study:

Other Schooling:

Please comment on your reasons for entering the program, reactions to the problems of adult illiteracy, and any personal qualities you feel might contribute to your success as a volunteer in the program.