Family English Learning Support: Learner Application – Halifax Public Libraries

Application: Family English Learning Support

Parent Information

Parent-1 Name(Required)

First Last

Parent-1 Immigration Status(Required)

Permanent Resident

Temporary Resident

Refugee / Protected Person

Other

Parent-1 Birth Date(Required)

Parent-2 Name

First Last

Parent-2 Immigration Status

Permanent Resident

Temporary Resident

Refugee / Protected Person

Other

Parent-2 Birth Date

Family Home Address(Required)

Street Address Address Line 2 City Province Postal Code

Phone Number(Required)

Email(Required)

Where & When

Which Session(Required)

Based on the available sessions posted on the previous page, what branch location are you applying for?

Library Branch

Time & Day

Participating Children Information

Participating Children(Required)

Child's Name

Age

Grade

What subjects require tutoring? (Math, Science, etc.)

Please use the (+) symbol to add children to the list.

Additional Comments (optional)

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Comments

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