Form G-1190 Free Training For Civics and Citizenship Teachers of Adu

Application for FREE Training for Civics and
Citizenship Teachers of Adults

USCIS
Form G-1190

Department of Homeland Security
U.S. Citizenship and Immigration Services

OMB No. 1615-0120
Expires 11/30/2017

Registration Form's Information

Draft
Not for
Production
04/25/2017

USCIS offers free training events for adult educators, volunteers, and teachers. These events are designed to enhance the skills needed
to teach U.S. history, civics, and the naturalization process to immigrant students. To find other available training materials, please
visit the Citizenship Resource Center at www.uscis.gov/citizenship.
To register for a training opportunity in your area, please complete and submit the registration form below. Please note there will be
no on-site registration the day of the event. Registrations will be accepted up to 10 business days in advance of the training date.
Space is limited. Dates, times, and locations are subject to change. Please visit our website at www.uscis.gov/teachertraining
regularly for the latest information.
Today's Date (mm/dd/yyyy)

Your Fax Number (with area code)

Training Location (City, State and Date)
City

State

Training Date (mm/dd/yyyy)

Registrant's Information

Registrant's Name
Registrant's First Name

Registrant's Last Name

You are a (check all that apply):
ESL Teacher
Other (specify):

EL/Civics Teacher

Citizenship Teacher

Organization Name

Volunteer

Administrator

Position Title

Street Number and Name

City

State

Registrant's Email Address (if any)

ZIP Code

Registrant's Telephone Number (including area code)

How did you hear about this training?
Presentation

Flier

Office of Citizenship Email

Newsletter

USCIS Website

Community Relations Officer

Coworker

My employer

Other (specify):

Please check this box if you do not want U.S. Citizenship and Immigration Services Office of Citizenship to contact you
in the future about its citizenship-related products, resources, and training opportunities. Please contact us at
office.of.citizenship@uscis.dhs.gov if you have registered with our site previously and would like to be removed from
our mailing list. NOTE: If you do not check the box, U.S. Citizenship and Immigration Services Office of Citizenship
will contact you in the future about its citizenship-related products, resources, and training opportunities.
Submit Registration Form by Email
Form G-1190 04/25/17

Or Fax to 202-272-1316
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Special Accommodations (needed at the event)
If you would like to request special accommodations to attend a training seminar, please contact us at office.of.citizenship@uscis.dhs.gov at
least one week prior to the training to allow us time to make arrangements.

USCIS Privacy Act Statement

Draft
Not for
Production
04/25/2017

AUTHORITY: The information requested on this form is collected pursuant to section 451(f)2 of the Homeland Security Act of
2002, Public Law 107-296.
PURPOSES: The primary purpose for providing the requested information on this form is to register for a USCIS Office of
Citizenship sponsored Teacher Training Seminar and to deliver future updates regarding citizenship-related products, resources, and
training opportunities.
DISCLOSURE: The information you provide is voluntary; however, failure to provide full contact information may prevent you
from successfully registering for a USCIS sponsored Teacher Training seminar.
ROUTINE USES: The information will be used by and disclosed to DHS personnel and contractors or other agents who need the
information to register individuals for a USCIS sponsored Teacher Training Seminar and to deliver future updates regarding USCIS
citizenship-related products, resources, and training opportunities. This includes using the information as necessary and authorized by
the routine uses published in DHS/All-002 Department of Homeland Security Mailing and Other Lists System of Records, available at
www.dhs.gov/privacy.

Paperwork Reduction Act

An agency may not conduct or sponsor an information collection, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. The public reporting burden for this collection of information is
estimated at 10 minutes per response, including the time for reviewing instructions and completing and submitting the form. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to: U.S. Citizenship and Immigration Services, Regulatory Coordination Division, Office of Policy and Strategy, 20
Massachusetts Ave., NW, Washington, DC 20529-2020; OMB No. 1615-0120. Do not mail your application to this address.

Form G-1190 04/25/17

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