Family Discovery Center
1010 Grandin Avenue
Rockville, Maryland 20851
(301) 424-2989
Adult ESOL Student Registration Form
Our 2026 Fall ESOL session is Monday, September 14th through Thursday, December 12, 2026. Courses are open to pregnant women and families with children up to age four who reside in Montgomery County, Maryland. Free childcare is provided while students take their classes. *Registration is not a guarantee of course enrollment.*
Basic Information
Full Name
*
First Name
Middle Name
Last Name
Primary Phone Number
*
Please enter the phone number where you can be best reached.
Format: (000) 000-0000.
May we text you at this number?
Yes
No
Email
*
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Date of Birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
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12
13
14
15
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25
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29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
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1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Male
Female
Other, please specify
Primary Language
*
Please Select
American Sign Language
Amharic
Arabic
Bengali
Chinese/Mandarin
French
French Creole
German
Greek
Gujarati
Hebrew
Hindi
Korean
Persian (Farsi)
Portuguese
Russian
Spanish
Tagalog
Urdu
Vietnamese
Other
Ethnicity
*
Please Select
Hispanic or Latino
Non-Hispanic or Latino
Race
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Academic Background
Highest Year of School Completed
*
Please Select
0 - No Formal Education
1
2
3
4
5
6
7
8
9
10
11
12, No Diploma
High School Graduate
GED or Equivalent Education
Some College/University, No Degree
Associate's Degree
Bachelor's Degree
Master's Degree
Doctorate Degree
Education may have been in the United States or abroad.
Did you complete more than 50% of your education outside of the United States?
*
Please Select
Yes. More than 50% of my education was completed outside the United States.
No. 50% or less of my education was completed outside the United States.
Have you taken English (ESL/ESOL) classes before?
Yes
No
If you've taken English classes before, what level(s) did you take?
Beginning Literacy
Low Intermediate
Low Beginning
High Intermediate
High Beginning
Advanced
English Language Learning Goals
What is your estimated skill level of English?
Please Select
Beginner - No English or a few English words. (Difficulty following spoken and written instructions.)
Low Beginner - Can read and respond in short phrases and ask general questions.
Intermediate - Can comprehend some reading and can think in English.
Advanced
How well do you believe you can speak, listen, read, or write in English?
What is your primary goal for learning English? (Choose no more than two.)
Education
Family
Working/Career
Citizenship
Daily Living
Other
Choose three areas of English you want to improve the most.
Vocabulary
Grammar
Listening Comprehension
Speaking Confidence
Reading Skills
Writing Skills
Pronunciation
Other
Intake Exam and Class Schedule
Important Notice
Prospective students wishing to enroll into Adult ESOL courses at the Family Discovery Center must complete the CASAS placement exam. The CASAS placement exam includes a reading and listening assessment to help us place you in the appropriate class level. The placement exam is estimated to take three hours. Please plan to be with us for the full three hours.
Please select your CASAS placement exam date and time.
*
Please select your CASAS placement exam date and time.
*
Please select your preferred course for Summer Bridge.
*
Conversational English: MTW 10:00 AM - 12:00 PM
English Literacy: MTW 1:00 PM - 3:00 PM
Please select your preferred course for the 2026 Fall Session
*
Please Select
High Beginner/Low Intermediate: M/W 9:30AM - 12:00 PM
High Intermediate: M/W 1:00 PM - 4:00 PM *WAITLIST*
High Intermediate: T/TH 1:00 PM - 4:00 PM
Please select the age range of each child who will require childcare while you take your classes.
*
Rows
Child 1
Child 2
Child 3
Child 4
Age Range
I am pregnant
6 weeks to 14 months
15 months to 23 months
2 years
3 years
4 years
N/A
I am pregnant
6 weeks to 14 months
15 months to 23 months
2 years
3 years
4 years
N/A
I am pregnant
6 weeks to 14 months
15 months to 23 months
2 years
3 years
4 years
N/A
I am pregnant
6 weeks to 14 months
15 months to 23 months
2 years
3 years
4 years
N/A
Please verify that you are human
*
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