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 12/31/2020

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. We will accept registrations
up to 10 business days before 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. For special accommodation requests, please email the
office.of.citizenship@uscis.dhs.gov at least 45 days before the training.

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Registrant's Information
Registrant's Name
First Name

Last Name

Registrant's Email Address

Registrant's Telephone Number (including area code)

Name of Organization (if you are not connected to an organization, Type N/A)

Organization's Address (if N/A, this should not appear)

Zip Code

City

(USPS ZIP Code Lookup)

State

Training Location (City, State and Date)
Seminar Location

State

Seminar Date (mm/dd/yyyy)

How would you describe your program? (Select one)
Community-Based Organization

Library

Faith-Based Organization

Museum

Public School Adult Education

Business or other for-profit organization

College/University

Other (please specify)

What services are offered at your organization? (Select all that apply)
Citizenship Education

Family Literacy

ESL Classes

Legal Services

EL/Civics Classes

Filing N-400 Application for Naturalization Online

GED or other Test Prep Classes

Other (please specify)

Adult Basic Education

Form G-1190 12/06/17

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Training Location (City, State and Date) (continued)
What is your position in your organization? (Select all that apply)
Citizenship Teacher

Social Services Coordinator

ESL Teacher

Administrator (Other)

EL/Civics Teacher

Attorney/Legal Services Staff

Teacher (Other)

Librarian/Library Staff

Volunteer

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Museum Staff

Education Program Coordinator/
Administrator

Other (please specify)

In what capacity do you work in your organization? (Select one)

Full-time, paid

Part-time, paid

Volunteer

Approximately, how many of your students have naturalized in the past year? (Select one)
0

1-5

6-10

11-15

16-20

20+

Not sure

Do you use the educational resources on the USCIS Citizenship Resource Center? (Select one)

N/A

Yes

No

How did you hear about this training? (Select all that apply)
Flyer

Community relations officer

Newsletter

USCIS information session

USCIS website
Co-worker

Presentation

Social Media

Employer

Other (please specify)

Office of Citizenship email

Do you want USCIS' Office of Citizenship to contact you in the future about its citizenship-related products, resources, and training
opportunities? (Select one)
Yes

No

Form G-1190 12/06/17

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DHS Privacy Notice
AUTHORITY: The information requested on this form is collected under Homeland Security Act of 2002 Section 451(f)(2).
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 enable USCIS to deliver future updates regarding citizenship-related products,
resources, and training opportunities. DHS uses the information you provide to register you for the USCIS-sponsored Teacher
Training Seminar you are seeking to attend.
DISCLOSURE: The information you provide is voluntary. However, failure to provide full contact information may prevent you
from successfully registering and receiving information related to USCIS-sponsored Teacher Training seminars.

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ROUTINE USES: DHS may share the information you provide with DHS personnel and contractors or other agents who need the
information to register you for the USCIS-sponsored Teacher Training Seminar and to deliver future updates regarding USCIS
citizenship-related products, resources, and training opportunities. USCIS holds training events in government owned facilities, to
include a local county library, a public school institution, and other government facilities. USCIS may also share registration
information with the hosting organization. DHS follows approved routine uses described in the associated published system of
records notices [DHS/ALL-002 DHS Mailing and Other Lists System and DHS/ALL-003 - Department of Homeland Security General
Training Records] and the published privacy impact assessment [DHS/ALL/PIA-006 Department of Homeland Security General
Contact Lists] which you can find 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 Office of Management and Budget (OMB) control number. The public reporting
burden for this collection of information is estimated at 5 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 12/06/17

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