Transitions Tutoring Student Registration Form Please enable JavaScript in your browser to complete this form.Personal InformationName *FirstLastAddress *Address Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *EmailDate of Birth *MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDay *Year *Gender *ManWomanOtherDisability? *YesNoWhere are you from? *What is your first language? *Race/Ethnicity *Asian/Pacific IslanderBlack/African AmericanLatino/HispanicMulti-RacialNative American/American IndianSoutheast AsianWhite/CaucasianOtherEducation and WorkLast year of school? *0123456789101112HS Diploma/GEDUniversityDo you have a job? *Yes, full-timeYes, part-timeNo, but I want a jobNo, and I do NOT want a jobFamilyDo you or your children use: *BadgerCareWICSNAPFree/Reduced LunchDVRW-2NoDo you have children under 18? *YesNoChild's NameBirth YearSchool NameChild's Name (2nd child)Birth Year (2nd child)School Name (2nd child)Child's Name (3rd child)Birth Year (3rd child)School Name (3rd child)Child's Name (4th child)Birth Year (4th child)School Name (4th child)Permission to Share InformationCheck if you understand and agree: *I understand that Literacy Network and program partners will keep my information confidential when they work together. Literacy Network will make my information anonymous whenever possible.I understand that Literacy Network will call and text me about my classes this semester and in the future.Photo PermissionDo you want to be on our Facebook page, on our website, or in our newsletter? Literacy Network uses photos and writing to teach the community about our programs and the great things students do. Can we share your writing and photo? *Yes! You can use my first and last nameYes! Please use my first name onlyNo, I do not want to share my writing or photoAuthorization to Disclose Academic Information & GradesBy typing my name and digitally signing this form, I authorize Madison College School of Academic Advancement to disclose my academic-related information, including my personalized education plan (PEP) and test scores, with Literacy Network starting on 1/1/2024 and ending on 12/31/2027.. *Single Line Text *Single Line Text *CommentSubmit!