Los Monitos FLEXGROUPS Language Learning Community Survey

Welcome to the Los Monitos FLEXGROUPS Language Learning Community! FLEXGROUPS means no more published schedules to sort through, trying to decide if it fits your schedule or requiring you to alter your schedule to make it work. Instead, you give us your open days and times (that's the FLEX part) and we'll try to form a class around your availability! When we get enough people to form a group, your FLEXGROUP will start! Please give us more information about yourself, schedule, level of proficiency and objectives. Thank you!

1.Please give us your contact information(Required.)

Name:

Company (if applicable)

Address

Address 2

City / Town

State

Zip Code

E-mail

Cell Phone

2.What age category are you in?

Under 21 (we'll follow-up with you)

21-39

40-60

61+

3.How did you hear about Los Monitos? (mark all that apply)

Other (please specify)

4.What language do you want to study?(Required.)

Other (please specify)

6.How would you rate your current level of proficiency in the language?(Required.)

7.Please check all options and preferences that apply:

I want to learn the language for BUSINESS purposes

I want to learn the language for PERSONAL ENRICHMENT

I want to learn the language for TRAVEL

I would consider a TRAVEL program

I would consider a CULTURE-ORIENTED (arts, media, food, etc.) program

I would consider an IMMERSION program (taught entirely in target language)

I would like to be part of a facilitated CONVERSATION GROUP (may meet less frequently, have lower cost than learning groups)

I would consider PRIVATE or SEMI-PRIVATE instruction if a group cannot be formed with my preferences.

I would consider an ONLINE Group Class

Other (please specify)

8.Our Language Learning Groups run on a month by month basis for $99 per month. (75 minute sessions, 1X per week, 48 weeks per year.) Missed classes will be applied to future months at $20 credit per class (1 credit per month, while continuously enrolled).

If you want an additional 5% discount on your monthly group fee, go ahead and complete your PREFERRED payment method below. You will not be charged until a Group Formed Confirmation E-mail is sent and you confirm attendance.

You may cancel future monthly charges up to a week before next charge.

Credit Card Payments

Type of Card (Visa, master card, etc.):

Card Number:

Expiration Date:

Full Name on Card:

Billing Address (Street Address, City, State, Zip Code):

CVV Security Code:

9.Bank Draft Payments

Depository Bank Name:

Routing Number:

Bank Account Number:

Checking or Savings?

10.Status (FOR LM STAFF ONLY)