Initial Consultation & Goal Assessment

This intake form helps the counselor understand the student's background, language goals, destination preferences, and any special needs so we can recommend the most suitable language travel program.

Student Information

Full name (as on passport):

Date of birth:

Current school:

Current grade or year:

Email (student or parent):

Student phone:

Mailing address:

Current Language Level

Self-rated CEFR level:

A1 — Beginner

A2 — Elementary

B1 — Intermediate

B2 — Upper Intermediate

C1 — Advanced

C2 — Proficiency

Unsure

Placement test taken — score:

Previous language study or time abroad:

Travel Goals

What are you hoping to gain from this trip? Select all that apply.

Speaking confidence

IELTS preparation

TOEFL preparation

Cambridge preparation

Cultural immersion

Academic preparation

Gap Year

Business English

Junior summer or winter camp

Working Holiday preparation

Primary goal — describe in your own words:

Destination Preferences

Countries of interest:

USA

Canada

UK

Ireland

Malta

Australia

New Zealand

Japan

Philippines

South Africa

Other:

Preferred cities or regions:

Duration & Timing

Preferred duration:

2 weeks

4 weeks

8 weeks

12 weeks

Semester

6 months

Longer

Preferred departure window:

Latest acceptable return date:

Budget

Target total budget (with currency):

Airfare included in this budget?

Yes

No

Budget flexibility — how firm is the figure above?

What matters most when comparing programs?

School quality

Location

Accommodation comfort

Activities

Total cost

Special Needs

Anything we should know — dietary, allergies, medications, learning differences, mobility, mental health, religious observance:

Parent / Guardian Information

Required if the student is a minor.

Parent or guardian full name:

Relationship:

Phone:

Email:

Employer:

I confirm I am the financial sponsor for this program

Emergency contact (separate from parent/guardian):

Name:

Relationship:

Phone:

Email:

Consultation Notes

Counselor's summary of the conversation:

Next Steps

Agreed next steps and target dates:

Acknowledgement

I confirm the information above is accurate to the best of my knowledge

I consent to the agency sharing relevant details with partner schools and accommodation providers

I understand a written program quote will follow this consultation

Thank you for sharing this with us. Your counselor will use these notes to put together a program recommendation tailored to your goals and budget.