ESL of Queens College - A Part-Time Program

Application: print, fill out and mail in

 Name:

 Address:

 Home Phone:

 Business Phone:

 Email Address:

 Social Security Number:

 Place of Birth:

 How did you find out about this program?

Payment:

___Visa          ___MasterCard         ___Discover          ___Check/Money Order (made out to "Queens College-ESL")  

 Account Number:

 Expiration Date:

 Cardholder's Name:

 Signature:

Classes ($295 per class): I want to register for the following course(s): 

Course Number & Section 

 Amount Paid

Registration Fee 

 $20

Total Paid 

 

Mail application and payment for the full amount to:
English as a Second Language, Kiely 111, Queens College, Flushing, NY 11367-1597
You can also register online, in person, or by phone.
TEL: 718/997-5712, 5700 WEB: www.qc.edu/esl