NYMLK

ATTAIN Laboratory
Sign-in Form

Name
Address
Phone
Email Address
Age
Sex	Female Male
Marital Status
Native Language
Race/Ethnicity
How often do you plan to come to the ATTAIN Lab?
	Once a week
	Twice a week
	Three times a week
	Daily
When do you plan to come to the ATTAIN Lab? (Please check all that apply and indicate what hours are best for you)
Monday Hours
Tuesday Hours
Wednesday Hours
Thursday Hours
Friday Hours
Saturday Hours
How do you plan to use the MLK ATTAIN Laboratory? (Please check all that apply)
	To learn new information
	To learn more about what I'm studying in school
	To prepare for an exam (e.g. GED)
	For career exploration
	To fulfill course/program requirements
	I wanted to explore a new learning tool
	To send/receive e-mail messages
	For general computer use
	For Internet research
	Other: Please explain

576 EAST 165TH STREET * BRONX, NEW YORK 10456 * (718) 589-7858 ext. 8 * FAX (718) 589-7973
email: nymlk@sunyeoc.org