870-864-7081
About Us
Programs
Contact
Literacy Council Student Application
Personal Information
First Name:
Last Name:
Email:
Phone:
Address:
City:
State:
Zip Code:
Date of Birth:
Gender:
Male
Female
Marital Status:
Single
Married
Widowed
Ethnic Group:
Caucasian
African-American
Hispanic
Native American
Asian
Other
Education Level:
8th
9th
10th
11th
12th
High School Diploma
Other
What is your goal?
GED
Reading/Math
Computer Use
Driver's License
Best time for tutoring session:
Have you been tested at South Ark?
Yes
No
Do you have test scores?
Yes
No
Are you... (Check all that apply)
Employed
Unemployed
Not in labor market
Disabled
Assisted Living
Current Military
Veteran
Emergency Contact Information
Please indicate a person to contact if there is an emergency on a volunteer site.
Name:
Phone:
Address:
City:
State:
Zip Code:
By checking the box, I certify that the above information is true and correct.
Enter Security Code: