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Individual Instruction Information Form

This form must be filled out completely before a contract for instruction can be processed.
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Name
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Email
Telephone
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Address 1
Address 2
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City
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State
select
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ZIP
  
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How many weeks of individual instruction are you interested in? (e.g. 15 weeks)
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How many meetings per week would you like to have? (e.g. 2 meetings per week)
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How many hours per meeting would you like? (e.g. 2 hours each time)
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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)
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What would you like to study? (check all those that apply)
When would you like to begin instruction?
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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.