First Name

Last Name

Email Address

Phone

Country Region

Address

City

Zip / Postal Code

Select Language Class Select Language Classneme yadua (Paiute)maqlaqsyals (Klamath/Modoc)

Select Class Level Select Class LevelBeginner (Fall)Intermediate (Winter)Advanced (Spring)

Number of Adults Joining

Number of Children Joining

Short Survey on Language Knowledge and Use. Select what describes you best Short Survey on Language Knowledge and Use. Select what describes you best I can speak 0-20 tribal words I can speak 20-50 tribal words I can speak 50-100 tribal words I can speak more than 100 tribal words There is a fluent speaker in my family There is NOT a fluent speaker in my family I grew up hearing the language I did NOT grow up hearing the language I did not attend boarding school I attended boarding school

Student Signature