Form G-1190 Free Training for Civics and Citizenship of Adults

OMB-NEW; Expires xx/xx/xxxx

Form G-1190, FREE Training for Civics
and Citizenship Teachers of Adults

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

Registration Form
USCIS offers free training workshops for adult educators, volunteers, and teachers. These workshops 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.

DRAFT
NOT
FOR
PRODUCTION

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 Web site at www.uscis.gov/teachertraining regularly for
the latest information.
Today's Date (mm/dd/yyyy):
Training Location:

Your Fax Number (with area code):
Training Date (mm/dd/yyyy):

PARTICIPANT INFORMATION

You are a (check all that apply):
ESL Teacher
EL/Civics Teacher
Citizenship Teacher
Other:

First Name:
Last Name:

Volunteer
Administrator

(Specify)

Organization:

Title:

Email Address:

Street Address:
City:

State:

Zip Code:

Flier
Coworker

Newsletter
My employer

Phone Number (with area code):

How did you hear about this training?

Presentation
USCIS Web site
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 [email protected]
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 E-Mail
Accommodations
If you are in need of an accommodation, please contact us at [email protected] within one week of the training to allow
us time to make arrangements.
Privacy Act Statement
AUTHORITY – Homeland Security Act of 2002, Public Law 107-296, Section 451(f)(2). The Office of Citizenship is authorized “to
promote instruction and training on citizenship responsibilities for aliens interested in becoming naturalized citizens of the United
States, including the development of educational materials.”
Form G-1190 (Rev. 09/21/11) N

PURPOSES – To provide a formal registration mechanism for individuals to register for a U.S. Citizenship and Immigration Services
(USCIS) Office of Citizenship sponsored Teacher Training Workshop. Contact information (i.e., email addresses) may also be used to
provide information regarding USCIS Office of Citizenship citizenship-related products, resources, and training opportunities.
ROUTINE USES – The information collected will be used to register individuals for a USCIS Office of Citizenship sponsored
Teacher Training Workshop and to deliver future updates regarding USCIS Office of Citizenship 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 November 25, 2008, 73 FR 71659.

DRAFT
NOT
FOR
PRODUCTION

DISCLOSURE – Providing this information is voluntary; however, failure to provide full contact information may prevent you from
being registered for a USCIS Office of Citizenship sponsored Teacher Training Workshop.
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 Products Division, Office of the
Executive Secretariat, 20 Massachusetts Ave., N.W., Washington, DC 20529-2020. Do not mail your application to this address.

Form G-1190 (Rev. 09/21/11) N