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Confident College Coaching Consult Request
Hello! Please complete this form to help me get to know your needs. I will contact you to set up a free initial session.
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Email
*
Your email
Parent(s)/Guardian(s) First Name
*
Your answer
Parent(s)/Guardian(s) Last Name
Your answer
Best contact phone number
Your answer
Student's first name
*
Your answer
Student's last name
*
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
*
Your answer
What is your student's current grade in school?
*
If your student is between grades, please select the grade he/she/they are going into next school year.
Middle School (grades 6-8)
Grade 9
Grade 10
Grade 11
Grade 12
Are you interested in a comprehensive program or a la carte options?
*
Comprehensive yearly program
a la carte options
Unsure at this time
What are your goals with academic or college coaching?
Your answer
What is your availability for a phone or Zoom conference within the next week?
If you need a specific date/time, please indicate that in the following question.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning
Afternoon
Evening
Do you have any questions or additional comments?
Your answer
A copy of your responses will be emailed to the address you provided.
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