Online Grasshopper Language Learning: Client Intake Form
Please fill in the form below. This should take approximately 5-10 minutes to complete
Contact Information
Student Name*
First Name Last Name
E-mail*
About you
List any languages you know and your fluency in each. (1 = low fluency, 5 = native speaker fluency)*
ex. Arabic(4), French (2), English (5)
Which language(s) are you interested in learning with me?*
English (ESL / EFL) Spanish French Portuguese Mandarin Chinese
What is your current fluency in the language you would like to learn? (0 = nothing, 5 = native speaker fluency)*
0 1 2 3 4 5
Reading
Writing
Listening
Speaking
Overall
Please describe any experience you have had with this language in an immersion environment with native speakers.
Please include details. (approximate dates, length of time, locations)
Please describe any previous classes or tutoring sessions you have completed in this language.
Please include details. (total length of time studying this language)
Language Goals and Learning Style
What learning styles or resources work best for you?
(topic conversation, songs, pictures, games, etc.) If none, leave blank.
What is the general reason(s) you are interested in learning this language?*
(work, business, school, immigration, travel, conversation, personal interest)
What are 3 specific language goals you would like to work towards in your sessions with me?*
(travel basics, sentence fundamentals, increased vocabulary, refined pronunciation, listening comprehension, giving presentations, answering emails, conversation skills, etc.)
If you are learning this language for an upcoming immersion experience, which location and date will you be traveling or moving abroad?
If you are not, leave blank. If you are, please indicate if you need to finish your classes by this date, or if will you resume classes upon returning.
How many hours of homework / practice are you able to do each week?*
Homework is a great way to keep the language active between practice.
What kind of materials should I prepare you for homework?*
(review, new material or vocabulary, games, exercises, native speaker content - like kids books, online articles, songs, videos, etc.)
What topics interest you most in this language, or in general, that I could try to incorporate into our lessons?
(salsa music, telenovelas, Brazilian capoeira, French films, TED talks, Chinese caligraphy, Youtube videos, etc.)
Is there any other useful or relevant information about you or your learning style?
If no, leave blank.
Student Agreement
Session fees are to be paid in full via email transfer to katrina@katrinakrogstad.com. A cancellation fee of the full session fee is applied to missed classes or cancellations with less than 24 hours of cancellation notice.*
I understand.
All cancellations, late arrivals, or rescheduling by the student must be done by instant message or phone call (not email) and must receive confirmation.*
I understand.
The student is expected to sign in on time for each session. The tutor is not responsible for lost time due to the student (i.e. signing onto the call, off-topic conversation) and will only teach during the booked time slot. In a rare case where the tutor is late, the lost time will be made up, either by extending the current lesson or a future lesson by the time missed.*
I understand.
If the tutor cancels with less than 24 hours (ex. due to illness), the tutor will reschedule the appointment. The tutor will give 24 hours prior notice to the student whenever possible.*
I understand.
Progress is ultimately the student’s responsibility, based on their own commitment, both during and outside of class. The student, in addition to the tutor, should keep a record of all classes, attended or cancelled. The student is also responsible for the cost of all study materials.*
I understand.
Thank you for taking the time to fill this out.
I look forward to discussing your answers with you in our initial consultation!
Newsletter
Yes, subscribe me to the Grasshopper Language Learning newsletter for occasional updates and promotions.
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Online Grasshopper Language Learning: Client Intake Form

Contact Information

About you

Language Goals and Learning Style

Student Agreement

Thank you for taking the time to fill this out.