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Student Registration Form

Free BNL English for Speakers of Other Languages (ESOL) classes are offered only to BNL employees, users, visiting scientists and their spouses or partners. The classes are not open to the public.

*All fields are required.

Name: Gender: Male Female
Your home is:Off-Site     OnSite  
 
Home Phone: Okay to call home? Yes No
Lab Phone: Okay to call work? Yes No
e-mail: Okay to send e-mail? Yes No
Primary Language: Native Country:
 
When are you available to attend ESOL classes? (Check as many as possible.)
Monday: Morning    Lunchtime    Afternoon    Evening
Tuesday: Morning    Lunchtime    Afternoon    Evening
Wednesday: Morning    Lunchtime    Afternoon    Evening
Thursday: Morning    Lunchtime    Afternoon    Evening
Friday: Morning    Lunchtime    Afternoon    Evening
 
Have you studied English before? Yes No
How will you get to class? Drive     Walk     Friend/Family
 
Occupation:
Scientist     Researcher     Homemaker     BNL Employee
Other:
 
Marital Status:
Single     Married     Divorced     Widowed     Separated
 
Children? Yes     No     If yes, number of children:
Is childcare a problem? Yes No Is transportation a problem? Yes No
 
What is your expected departure date from the Lab:
 
Interests:

    

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Last Modified: February 1, 2008
Please forward all questions about this site to: Jennifer Lynch
 


DOE, Office of ScienceOne of ten national laboratories overseen and primarily funded by the Office of Science of the U.S. Department of Energy (DOE), Brookhaven National Laboratory conducts research in the physical, biomedical, and environmental sciences, as well as in energy technologies and national security. Brookhaven Lab also builds and operates major scientific facilities available to university, industry and government researchers. Brookhaven is operated and managed for DOE’s Office of Science by Brookhaven Science Associates, a limited-liability company founded by Stony Brook University, the largest academic user of Laboratory facilities, and Battelle, a nonprofit, applied science and technology organization.

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