Do you have a desire to become a student in our program? Please fill out the form below and we will contact you.

Name:

E-Mail Address (required):
Address:
City:

State:

Zip Code:
Telephone:
What is your last grade completed?
What are your hobbies and interests?
What are your specific goals for this program? I would like to read better
I would like to get a better job and need to improve my skills
I would like to further my education
I would like to help my child with his/her homework
Other (describe below):
What is your language:
Best day/time to reach you to discuss the program:
When are you available to start the program?
Questions and/or Comments:



Kankakee Valley Adult Reading and Literacy Program
1 Dearborn Square, Suite 2 * Kankakee, IL 60901
(815) 922-5680
email: info@kvadultreading.org