Program Inquiry Form

Attention:

This form is for USWW members who are enrolled or want to enroll in BSP Language classes:

-Spanish 101/102 (Airport, Security) for English speakers

- American Sign Language 101/102

For general inquiries or to speak with a BSP staff member, please call or text:

323-205-6792(English/Tagalog/ASL)

310-467-8026 ( Espanol)

Participants Information

1)First Name

2)Middle Name

3)Last Name

4)LAX Employee ID( if applicable)

5)Cell Phone Number

6)Street Address

7)City

8)State

9)Zip code

10)Last 4 digits of SSN

(to check USWW membership)

Demographic Information

11)Date of Birth

MM/DD/YYYY

12)Gender?

13)Ethnicity:

14)Number of children in your household?(ages 0-17)

15)Did you change your home address within the last 12months, or plan to move in the next 12 months?

16) Would you like school transfer assistance (K-12)?

17)Are you interested in free BSP Programs for SEIU-USWW members? (check all that apply)