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Home
Students
Mens Classes
Womens Classes
About us
Get Involved
Contact
Give
Pamoja Registration
Pamoja House Registration Form
Please fill out this form and we will help you find a time for a placement test.
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Name
*
First
Last
Street Address
*
City
*
State
*
Zip Code
*
Cell Phone Number
*
Email
*
Home Phone Number
Place of Birth (Home Country)
*
Date of Birth
*
First Language
*
Gender
*
Female
Male
Are you married?
*
Yes
No
What are the names and ages of your children?
How many school years completed in home country?
*
How many school years in the U.S.?
*
How many years have you been in America?
*
Where do you work?
*
How did you hear about Pamoja House?
*
Check the classes you would like to attend?
*
ESL
Tutoring
Citizenship Class
Computer Class
Children's Homeschool Pod
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