Takelma Language Interest Survey

Contact Information

Please provide a current contact so you can be reached with information regarding the current language classes. For all classes, any interested person can find additional information about Takelma. Due to limited spacing within our classes, priority may be given to Tribal members and their families. 
1.What is your name?
2.What is your email address?
3.What is your phone number?
4.Please select if you are a Tribal Member and/or Tribal Employee.
5.Tribal ID Number
6.How old are you?
7.Will you be learning by yourself, or are you able to involve your family?
8.During the week, when are  you available? (note: times are in PST)
morning
afternoon
evening
This is the best day for me
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
9.What kind of classes are you interested in? (select all that apply)