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STUDENT DETAILS
2
LEARNING PROFILE
3
LESSON PREFERENCES
4
LETS GET TO KNOW YOU
APPLICATION FORM FOR ADULT STUDENTS
Name and Surname
Date of Birth
Age:
Gender
Boy
Girl
They/Them
Prefer not to say
Select your Country*
Select your city & time zone
-- Select timezone --
What language(s) do you speak at home? *
Email Address *
Phone Number (Optional)
Preferred Language for Communication:
English
Other:
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ENGLISH LEARNING PROFILE
What is your current English level (if known)?
Beginner
Elementary (A1-A2)
Intermediate (B1-B2)
Advanced C1-C2
Not sure
Why are you learning English? (Select all that apply)
Travel
Work or Business
University or Studies
Living Abroad
Speaking with friends/family
Personal growth
Exam preparation (e.g. IELTS, TOEFL, Cambridge)
Other
What skills would you like to focus on?
Speaking and conversation
Vocabulary
Reading
Writing
Grammar
Listening skills
Professional/Business English
Other
What are your English learning goals for the next 3-6 months?
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LESSON PREFERENCES
What type of device will you use for lessons?
Laptop/Desktop
Tablet
Smartphone
Do you have access to Zoom, Skype, or ClassIn?
Laptop/Desktop
No (I will install it)
When are you available for lessons? (Your local time)
Weekdays - Mornings
Weekdays - Afternoons
Weekdays - Evenings
Weekends - Mornings
Weekends - Afternoons
Weekends - Evenings
How many lessons per week are you planning to take?
1 lesson/week
2 lessons/week
3+ lessons/week
Not sure yet
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LETS GET TO KNOW
What do you do?
Working professional
University student
Job seeker
Stay-at-home parent
Retired
Other:
What are your interests or hobbies?
Is there anything else we should know to help personalize your lessons?
CONSENT AND AGREEMENT
I understand that lessons will take place online via Zoom, or Skype.
I agree to Smart Speak's Terms of Service and Code of Conduct.
I give consent for Smart Speak to use this information to create my student profile
Finish!
