Become a Learner Learner Interest Form Fill out this form to get help in reading and writing English. You can also call us at 510-745-1480. "*" indicates required fields Step 1 of 2 50% Services Needed* Adult (ages 17 and older) Youth (ages 7 -16) Learner Name* First Last If under 18: Parent/Caregiver Name First Last Phone: Adult Learner or Parent/Caregiver*Is it okay to text this number? Yes No Email: Adult Learner or Parent/Caregiver Preferred Branch:*AlbanyCastro ValleyCentervilleCherrylandDublinFremontIrvingtonNewarkNilesSan LorenzoUnion City What is your first language?* English Cantonese Mandarin Spanish Other What is your first language? HiddenDo you have trouble reading unknown words?* Yes No HiddenDo you have trouble remembering or understanding what you read?* Yes No Tell us about your reading needs:* I am ready to be a better reader! I have trouble reading some words I have trouble remembering or understanding I have/had an IEP or a reading specialist in school Tell us about your writing needs:* I am ready to write better! I have trouble getting my thoughts out I have trouble with sentences and paragraphs Spelling makes writing hard I have/had an IEP or a get extra help in school Tell us about your English speaking needs:* Speak without a translator (work, appointments, family)) I have trouble with basic English (Interests, schedules, requests) I have trouble understanding English speakers None, English is my first language HiddenWhich skills would you like to improve?*Choose all that apply Reading Writing Spelling NameThis field is for validation purposes and should be left unchanged.
