Become a Student - Family Resource Center

Date of Birth(Required)

Email Address(Required)

Home Phone

Cell Phone

Emergency Contact Person(Required)

Emergency Contact Phone Number(Required)

Relationship To Student(Required)

Native Language(Required)

Country of Origin(Required)

Other Languages(Required)

Please list the date(s) of the conviction(s), the city and state, and the offense(s).(Required)

Other Industry(Required)

Occupation

Employer

Number in Household(Required)

Number of Adults(Required)

Number of Dependents under 18(Required)

Number of Children K-6(Required)

Number of Infants - Pre-K(Required)

When are you available?

Please check all that apply.

Signature(Required)

I understand that a criminal background check will be performed by the Literacy Council of Sheboygan County, before I am enrolled as a student. 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.

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