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Private Lessons Inquiry Form

Please complete the form below. The items marked * are mandatory.

Personal Information:

Title *

First Name*

Last Name*

Birth Date
(Mandatory for Kids only)

(mm/dd/yyyy)

Age Range (Adults)

Home phone*

Cell phone

Work Situation

Office phone

Company Name
(If responsible for payment)

E-Mail*

Fax

Address*

Street: Apt.#

City: State: Zip:

Lesson Requirements:

Have you taken a class with us before? Yes No
Location of Class:	At Our Location	Yes
	At Your Location: (Please specify address, intersection and subway)
Number of Hours per week:
Frequency of Classes:
Starting Date:
Availability (days & times):
Level of French:	(101, 102 ... )
	(If not a Beginner Level Student, please take the Placement Test first)
Reason for studying French:
Where did you hear about us?	New York Times Time Out NY FIAF Events Calendar FIAF Language Center Brochure Word of Mouth Web Search

Training Objectives:

Comments:

Feel free to use the box below if you have any comment /suggestion regarding your registration on this form.