DEAF, Inc. Adult Education Classes online Application Form- Print Version

Course: Circle One
American Sign Language Classes for all (Deaf, Hearing, Deaf Blind, Hard of Hearing)
ASL I - ASL II - ASL III - ASL IV - ASL V - Baby Sign Language

Instructions: Type or print clearly in black or blue ink. Answer all questions. Mail to ASL Program, DEAF, Inc., 215 Brighton Avenue, Allston , MA 02134


Date: ___________________

Name: __________________________________________________ Date of Birth: ________________

Address: _____________________________ City/State/Zip Code: _____________________________

E-Mail: ________________________ Phone Number: (_____)_______________ (please circle) TTY Voice VP

How did you hear about our ASL classes here? __________________________

Do you get letters and flyers from DEAF, Inc? (please circle) YES NO

If no, do you want us to send you letters and flyers? (please circle) YES NO

How did you find out about this class at DEAF, Inc? _________________________________________

What is your ethnicity: (please circle) White, Black, Hispanic, Asian, Other: __________________________

Comments: _____________________________________________________________________________


If you are an MRC or MCB client, there may be funding available for work related classes.
Contact Jennifer Glinos for more information.

All the information I wrote on this form is true:

_____________________________________
Your Signature

_____________________________________
Print Name

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For office Use Only:

Payment Date: ______________ Payment Cleared: ______________

Payment Amount: ___________ Receipt Sent: __________________

Payment Type: _____________ Comments: ____________________