ESL Intake Form :: Basic and Transitional Studies Forms

Application Quarter(Required)

Student Status(Required)

Returning ESL Student

New ESL Student

Transferring from another College or Community-Based Organization

Returning student will want to apply with us for the Fall in August. Please watch our website for details. If you apply today you may be put into a Readiness Class and not a level class. Please return to our website in August.

You must have a ctcLInk ID before applying to the ESL program. Please visit this website to apply. Program applications submitted without a ctcLink ID will not be processed and you will be asked to reapply. https://www.bellevuecollege.edu/admissions/

ctcLink ID#: Example 202****** REQUIRED(Required)

Contact Information

First Name(Required)

Please use your legal name. We are not able to register students who use alternative or preferred names.

Last Name(Required)

Please use your legal name. We are not able to register students who use alternative or preferred names.

Birth Date - Month/Date/Year(Required)

Phone Number(Required)

Please provide a number we can reach out at if needed.

Personal Email(Required)

Please provide a working email address. We will email you to confirm enrollment.

Bellevue College requires you to have a BC email. Your NetID allows you to access your college email account. Canvas (BC's learning management system), computer labs, and more. Your NetId is created online and requires your CTCLink ID and birthday. You can set up your NetID here: https://www2.bellevuecollege.edu/netid/CreateNewAccount.aspx

Bellevue College Email

Bellevue College requires that you use a BC email.

Bio-demographic Data

Gender:(Required)

Male

Female

Not Exclusively Male or Female

Choose your ORIENTATION (READINESS) class times:(Required)

Morning 10:30 12:20

Evening 5:30-7:20

Either Time

Attendance is crucial to finish the class. If you are not here 80 percent of the time, you will need to take the class again.(Required)

I agree to be here the entire quarter.

Choose your ESL LEVEL:(Required)

Beginning Level (No English) 1 and 2 . I can read a few words without translating. I can write the letters in the alphabet or I can write some words. I can speak a few words or I cannot speak any words. I understand a few words that I hear or I do not understand any words that I hear.

Middle Level (Some Basic English) 3 and 4. I can read many words without translating. I can write simple sentences or a short paragraph. I can speak some words or I can have simple conversations. I understand some words that I hear.

Advanced Level (Advanced Basic English) 5 and 6. I can read about familiar topics and some new topics without translating. I can write sentences in a paragraph or I can write more than one paragraph. I can speak many words and can continue a conversation about familiar topics. I understand many words that I hear.

For more information about our Disability Resources, please contact the DRC at https://www.bellevuecollege.edu/drc/ For more information about programs connected to TANF, Apple Health, low income child care. Please contact our WorkForce office at https://www.bellevuecollege.edu/we/ If you are between the age of 16 to 21 years old, please contact our Language Integration Program (LIP) program at https://www.bellevuecollege.edu/ceo/lip/

Photo Release(Required)

I, the undersigned, consent to each and every use by Bellevue College, and all of its officers, employees, and agents of 1) each photograph, videotape or other likeness of me taken/recorded on (date) and/or 2) comments provided in interviews on (date) and/or in writing. Such uses may include, but are not limited to, every use in a publication, newspaper, advertisement, web site, videotape presentation, television show or other publication or recording. I also waive any right to compensation for such uses, or to inspect or approve the uses beforehand. I release Bellevue College, its legal representatives and all persons acting under its permission or authority, from any liability for any blurring, distortion, alteration or optical illusion that may occur with these pictures. I, the undersigned, consent to each and every use by Bellevue College, and all of its officers, employees, and agents of 1) each photograph, videotape or other likeness of me taken/recorded on (date) and/or 2) comments provided in interviews on (date) and/or in writing. Such uses may include, but are not limited to, every use in a publication, newspaper, advertisement, web site, videotape presentation, television show or other publication or recording. I also waive any right to compensation for such uses, or to inspect or approve the uses beforehand. I release Bellevue College, its legal representatives and all persons acting under its permission or authority, from any liability for any blurring, distortion, alteration or optical illusion that may occur with these pictures.

I Agree

I Decline

Bellevue College does not discriminate on the basis of race, color, national origin, language, sex, sexual orientation, including gender identity or expression, disability, or age in its programs and activities. Please see policy 4150 at www.bellevuecollege.edu/policies/. The following people have been designated to handle inquiries regarding nondiscrimination policies: Title IX Coordinator, 425-564-2641, Office C227, and EEOC/504 Compliance Officer, 425-564-2178, Office R130.

Consent Signature Initials:(Required)

I agree to be bound by the terms of this Electronic Consent Agreement with the Photo Release Policy and Permission to use your SSN Policy. I also consent to the use of electronic signatures in place of written documents and handwritten signatures and to electronic communications.

Comments

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ESL Intake Form

ESL Intake Form

Contact Information

Bio-demographic Data

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