Become a Student

New Student Intake Form

Information on this form is used for reports to our funding sources and for program development. We do not share your personal identifying information.

Address

Contact Info

Emergency Contact

*Answering YES will not necessarily disqualify you from our program. If you answered YES, please list the date(s) of the conviction(s), the city and state, and the offense(s).

I understand that a criminal background check will be performed by the Literacy Council of Sheboygan County before I am accepted as a volunteer. I authorize any institution, information agency, or law enforcement agency to furnish any and all related information.

Any information received as a result of a background check is kept strictly confidential.

Language

Other Information

  • TANF
  • DVR
  • W-2
  • Wisconsin Shares Child Care
  • Kinship Care
  • SSI
  • Workforce Development
  • Trial Employment Match
  • Transitional Jobs
  • Income at or Below Poverty Level

Household Information

Tutors and students meet at their local public library or another public location.

Elkhart Lake
Sheboygan
Kiel
Sheboygan Falls
Plymouth
Random Lake
Oostburg

When will you be available? Check all that apply

9:00am-10:00am
10:00am-11:00am
11:00am-12:00pm
12:00pm-1:00pm
1:00pm-2:00pm
2:00pm-3:00pm
3:00pm-4:00pm
4:00pm-5:00pm
5:00pm-6:00pm
6:00pm-7:00pm
7:00pm-8:00pm
9:00am-10:00am
10:00am-11:00am
11:00am-12:00pm
12:00pm-1:00pm
1:00pm-2:00pm
2:00pm-3:00pm
3:00pm-4:00pm
4:00pm-5:00pm
5:00pm-6:00pm
6:00pm-7:00pm
7:00pm-8:00pm
9:00am-10:00am
10:00am-11:00am
11:00am-12:00pm
12:00pm-1:00pm
1:00pm-2:00pm
2:00pm-3:00pm
3:00pm-4:00pm
4:00pm-5:00pm
5:00pm-6:00pm
6:00pm-7:00pm
7:00pm-8:00pm
9:00am-10:00am
10:00am-11:00am
11:00am-12:00pm
12:00pm-1:00pm
1:00pm-2:00pm
2:00pm-3:00pm
3:00pm-4:00pm
4:00pm-5:00pm
5:00pm-6:00pm
6:00pm-7:00pm
7:00pm-8:00pm
9:00am-10:00am
10:00am-11:00am
11:00am-12:00pm
12:00pm-1:00pm
1:00pm-2:00pm
2:00pm-3:00pm
3:00pm-4:00pm
4:00pm-5:00pm
5:00pm-6:00pm
6:00pm-7:00pm
7:00pm-8:00pm
9:00am-10:00am
10:00am-11:00am
11:00am-12:00pm
12:00pm-1:00pm
1:00pm-2:00pm
2:00pm-3:00pm
3:00pm-4:00pm
4:00pm-5:00pm
5:00pm-6:00pm
6:00pm-7:00pm
7:00pm-8:00pm