Individual Instruction Information Form - (Homepage)

This form must be filled out completely before a contract for instruction can be processed.

Name

Telephone

Address 1

Address 2

City

State

select

ZIP

* How many weeks of individual instruction are you interested in? (e.g. 15 weeks)

* How many meetings per week would you like to have? (e.g. 2 meetings per week)

* How many hours per meeting would you like? (e.g. 2 hours each time)

* What is the total number of hours of individual instruction that you would like to have? (e.g. 2 meetings per week X 2 hours each time, for 15 weeks = 60 total hours)

* What would you like to study? (check all those that apply)
Listening & SpeakingReading & VocabularyWriting & Sentence StructureOther

When would you like to begin instruction?

Open the calendar popup.

* Have you studied ESL previously? If yes, please state number of years, number of months and course of study.

*Security Code:

The cost for individualized instruction is $45 per hour. A contract will be created using the information above. A contract will be mailed to you upon receipt of the above form for review and signature. You must return the signed contract and full payment (US bank checks only/ no cash accepted) prior to beginning instruction.

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