PFA Assessment Form

Training Assessment Form

Please complete the following form so that we can make training recommendations and guide you towards the most appropriate class for your particular needs. All information will be kept STRICTLY CONFIDENTIAL and will be used only for your educational development. Thank you in advance for your time and interest!
Survey location:
Please select where you physically were when you filled out the form.
Name *

First Name Middle Name Last Name
Date *

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone *

Area Code Phone Number
E-mail *
example@example.com
County of residence: *
Gender *
Birth date: *

Month Day Year
Age: *
Would you like us to call you? *
Would you like us to reach out to you directly?
When?
What's the best time to reach you?
How? *
How would you like us to contact you?
Which course are you interested in? *
Additional training interests? *
What would you like to learn? please be specific.
Please list any physical limitations or considerations. *
For example, do you wear corrective lenses?
Select one: *
Which best describes you?
Are you a veteran or first responder? *
Select all that apply:

Active Duty Retired Army Navy Air force Marines Police Fire Coast Guard Reserves National Guard EMT / Medical Foreign military
Are there any children in the household?
If there are children in the household, please list their ages.
Are there any other adults in the household?
If there are other adults in the household, please briefly state their relationship to you and attitude towards firearms.
Example: my roommate who is afraid of guns, my wife who loves guns, etc.
How did you hear about us? *
List any firearms education and experience. *
Which best describes your attitude towards your learning?
Select one
Which best describes you? (Select all that apply): *

I've never seen a real gun up close I've seen but never shot a gun I've shot a gun a few times I shoot guns regularly I grew up around guns
Do you own a gun? *
Select one
If yes to above:
List the makes, modes and calibers of your guns.
Which best describes your attitude towards your learning?
Select one
Select all that you own: *

A revolver A semi-automatic pistol A shotgun A rifle All of the above None of the above
If you own (or are planning to own) a firearm, which of the following would you use it for?:

Home defense Concealed carry Recreational target shooting Hunting All of the above None of the above
Are you a member of a gun range? *
Select one
Do you have a carry permit? *
Select one
If you don't have a permit, are you interested in obtaining one?
Select one
If you have a carry permit, how often do you carry?
Select one
Please answer the following

On a scale of 1 - 5, with 1 being the LEAST and 5 being the MOST, answer the following.

How comfortable are you around loaded firearms? *

	1	2	3	4	5

1 is Uncomfortable, 5 is Comfortable

How strong do you feel your firearms safety skills are? *

	1	2	3	4	5

1 is Weak, 5 is Strong

How accurately do you feel you can shoot a firearm? *

	1	2	3	4	5

1 is Not very, 5 is Very

How familiar are you with local gun laws? *

	1	2	3	4	5

1 is Unfamiliar, 5 is Familiar

Would you be willing to use your firearm to defend yourself or a loved one?
Select one
Would you be willing to use your firearm in self defense, even if it meant taking the life of another human being?
Select one
Which of the following concern you (select all that apply)?: *

Firearms accidents Home invasions Home burglary Sexual assault Your safety outside of the home Your families safety outside of the home Your ability to protect yourself and your loved ones All of the above None of the above
What other courses are you interested in (select all that apply)? : *

Defensive handgun Defensive shotgun Defensive rifle Personal protection inside of the home Personal protection outside of the home Women's only classes Use of deadly force laws Becoming a firearms instructor All of the above None of the above
Should be Empty:

Training Assessment Form

Please answer the following