ESOL Distance Learning Application

A free program for Boston area residents only. Please do not apply if you are not a Boston area resident.

Thank you for your interest in the Jackson Mann ESOL Distance Learning program!

To apply, please answer the questions below. Then press the Submit button.

Your application will be reviewed. If you are a good candidate, we will invite you to Jackson Mann in Allston for an orientation.

PLEASE SCROLL DOWN THE PAGE TO COMPLETE THE ENTIRE APPLICATION.
First Name
Last Name
Gender*

MaleFemale
Email*
Cell Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
Address*

Street Address

Apartment

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Age*
Country of Origin*
Main Language*
Other languages
What year did you come to the U.S.?*
How did you find out about our program?*
Your education (select one)*
WHEN DO I COME TO JACKSON MANN?

You come to Jackson Mann between 6:00 and 9:00 pm during the first 3 weeks to learn about the program and take a test. You return 3 or 4 times in the school year for a test or meetings.
Check all the evenings you are available.*

MondayTuesdayWednesdayThursdayNone of the above
Check all the days you are available for 2 hours between 2:00 and 6:00*

MondayTuesdayWednesdayThursdayNone of the above
HOW DO I STUDY?

You study at a computer for 5 to 6 hours each week. You make your own schedule. You must be able to hear sound from the computer and record your voice. It is good if your computer has a videocamera.
Can you study 5 or 6 hours every week on the computer?*

YesNo
Do you have a computer at home?*

YesNo
Do you use a computer at the library or a friend's house?*

YesNo
Check all the computers you use*

Windows NotebookWindows DesktopApple NotebookApple Desktopipadtablet
Do you share your computer?*

YesNoOther
How often do you use the computer?*

Every day4-6 times per weekOnce a weekLess than once a week
Does your computer have a microphone, or do you have a headset with a microphone?*

YesNoI don't know
Does your computer have a video camera?

YesNoI don't know
Do you use Skype?

YesNo
What is your Skype name?
Do you have a printer at home?*

YesNo
Do you use your cellphone to send text messages?*

YesNoI don't understand the question
Who is your cell phone provider? (Examples: At&T, T-Mobile)
INFORMATION ABOUT YOU

Please tell us about your work, your education, and your family.
Do you have one or more jobs?*

YesNo - I am looking for a jobNo - I am NOT looking for a job
What is your main job?
Is the job full-time or part-time?

Full timePart time
What City is the job in?
Do you have children living with you?*

YesNo
If yes, what years were they born? (example: 2008, 2011)
Are you a single parent?*

YesNo
DO YOU HAVE ANY QUESTIONS?
Should be Empty: