1-On-1 Pilot Program Intake Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Upon successful completion of this form, I will review your information and send you further details, including payment instructions.

As a reminder, NEVER submit payment (or other sensitive) information via Google Forms.

First Name *

Last Name *

Email Address *

Phone Number *

What times are you available?

Sessions are 2 hours long, and must be scheduled at the same time every week, for 4 weeks. Please check all times that you are available.

Mon

Tue

Wed

Thu

Fri

Sat

Sun

10am - 12pm

12pm - 2pm

2pm - 4pm

4pm - 6pm

Which payment plan works best for you? *

I will send you an invoice based on your answer.

$199 Monthly Installment Plan - 8 payments total

$1,199 Single Payment (Save an extra $393)

What would you like to work on during our sessions?

The more descriptive you are, the better. For example: "I want to gain a better understanding of how to use formulas, Pivot Tables, and charts. I also want to find ways to save time creating weekly reports for my job."

Anything else you would like me to know?

How excited are you? *

Meh

OMG LET'S DO THIS!

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of ExcelShir. Report Abuse

Forms