Life Curricula Interest Form

Interested in participating in the next minimester of Life Curricula? Let us know by completing the form below!

Home Address(Required)
MM slash DD slash YYYY
Can we text you at this number?(Required)
Do you check this email regularly?(Required)
Highest Education Level Completed
Do you need childcare? (Offered ages 2-12) Select Yes or No:(Required)
Do you have access to transportation?(Required)
Do you have any food allergies?(Required)
I am interested in the following course dates: (select all that apply)(Required)
I am interested in the following courses: (select all that apply)(Required)
Please select your first choice course: (select 1)(Required)
Please select your second choice course: (select 1)(Required)