Student Intake form
Please fill out this form so I can create a syllabus for our English Course.
Email *
Full Name *
Today's Date
Phone number *
City, Country
Are you
Clear selection
How many lessons do you want per week?
Clear selection
What days / times do you want lessons?
Recommended setup for online lessons:
What is your internet Download speed
What is your internet Upload speed?
Which of the following voice/video can you use on your computer?
When did you last take an English course? What was your level?
Why is learning English important for you now?
What is your job? (If you are a student, what do you study?)
What is the most important for you?
What is the 2nd most important for you?
What is the 3rd most important for you?
Choose 2 items that are the LEAST important for you
How often would you like to be corrected in a class?
Clear selection
In what situations do you WANT or NEED to speak English?
What themes would you like to study in the course? (check all that you like)
Are you interested in doing English homework outside of class? Check all that you want.
Do you need extra help from the teacher outside of class time? For what?
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