Language Travel Agency
Initial consultation, program recommendation and quote, visa application checklist, pre-departure briefing, and mid-stay & wrap-up feedback for short-term language travel and study-abroad agencies
Get started with PocperInitial consultation, program recommendation and quote, visa application checklist, pre-departure briefing, and mid-stay & wrap-up feedback for short-term language travel and study-abroad agencies
Get started with PocperThis 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.
Full name (as on passport):
Date of birth:
Current school:
Current grade or year:
Email (student or parent):
Student phone:
Mailing address:
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:
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:
Countries of interest:
USA
Canada
UK
Ireland
Malta
Australia
New Zealand
Japan
Philippines
South Africa
Other:
Preferred cities or regions:
Preferred duration:
2 weeks
4 weeks
8 weeks
12 weeks
Semester
6 months
Longer
Preferred departure window:
Latest acceptable return date:
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
Anything we should know — dietary, allergies, medications, learning differences, mobility, mental health, religious observance:
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:
Counselor's summary of the conversation:
Agreed next steps and target dates:
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.
The Initial Consultation & Goal Assessment template is a ready-to-use form from Pocper's Language Travel Agency pack. Customize the fields to match your workflow, then share a link so clients can complete it and upload documents in real time.