Buffalo Public Schools Adult Education Division
ESL Registration Form
   (* Denotes Required Field)
Employment Status
Have you attended our classes before?
What kind of classes are you interested in?
When are you available to take online classes?
Do you think your English speaking ability is...
Do you think your English reading ability is...
Do you think your English writing ability is...
How did you hear about our classes?
Did you complete this form yourself or dd someone help you?

Release of Information: By participating in this state and/or federally funded adult education and/or family literacy program, I agree to the release of the information contained in my program records, including, but not limited to, social security number, assessment results and attendance, to the New York State Department of Education (NYSED). Required information for learner participation is indicated with an asterisk (*). This information may include follow-up with employment data and other educational records and will be used in aggregated or non-personally identifiable form, for reporting as required by state and federal laws. This information may also be used for research and analysis purposes during this year and/or subsequent years, Information provided will remain secure. Unless otherwise noted, only NYSED, its authorized contractors or the local program will have exclusive access to this information.

Sign Your Name:

VISIT:

389 Virginia St.

Buffalo, NY 14201

CALL:

T: 716. 888. 7088 ext. 100
F: 716. 888. 7097

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© 2021 by Buffalo Public Schools Adult Education Division