Confidence Academics Intake Form

1

Hi! Who are you completing this form for?

Myself

My student

2

Nice to meet you! What's your name?

First Name

Last Name

5

What time(s) of day works best for our sessions?Note: Confidence Academics operates in Central Standard Time (CST)

Mornings

Afternoons

Evenings

It varies

6

What's your email address?* This field is required.We'll never spam you, and this form is protected with 256-bit SSL encryption.

example@example.com

7

What's your phone number?We'll never spam you, and this form is protected with 256-bit SSL encryption.

Area Code

Phone Number

8

Anything else we should know before we reach out?Examples: What are your goals? What do you struggle with most?