Immigrant Education Initiative Contact Form
Medgar Evers College
Division of Adult and Continuing Education
CUNY Immigrant Education Initiative


Please complete the form below in order to be invited to an information session about the CUNY Immigrant Education Initiative / DACA (Deferred Action for early Childhood Arrivals) program for immigrants under the age of 31. We also offer both ESL, GED/HSE and College Prep courses for anyone 17 yrs and older.


For further information about the program, please call 1-718-804-8880 or 1-718-804-8870









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First Name / Primer Nombre / Prénom / Premye Non *
Last Name / Apellido / Nom de Famille / Non Dènye *
Date of Birth / Fecha de Nacimiento / Date de Naissance / Dat li Fèt *
MM
/
DD
/
YYYY
Age / edad / âge / gen laj
Gender / Sexo / Sexe / Sèks *
Address / Señas / Adresse / Adrès *
Phone Number / Número de Teléfono /  Numéro de Téléphone / Nimewo Telefòn *
E-MAIL / IMÈL *
Did you come to the United States before your 16th birthday?  ¿Has venido a los Estados Unidos antes de su cumpleaños número 16? / Etes-vous venu aux États-Unis avant de vous aviez 16 ans? *
What Year did you enter the U.S? / ¿En qué año se introduce el U.S? / En quelle année êtes-vous entré la Americaines? / *
Which service are you interested in? / ¿Qué servicio le interesa? / Quel service vous intéresse? *
Have you resided in the U.S. since June 15th 2007? /  Ha residido en los EE.UU. desde el 15 de Junio ​​de 2007 ¿ /  Avez-vous résidé aux États-Unis depuis le 15 Juin 2007? *
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