Lesson Request Form

To inquire about lessons and request an initial session (current rates apply), please fill out and submit this form.

(* = required)

    Your Name *

    Your E-mail *

    Your City/Town *

    Which Describes You? *

    What's your status? *

    How long have you been studying? *

    Transfer students are required to have the consent of their current teachers to schedule a lesson. Do you have your current teacher's consent? *
    Yes, I have my current teacher's consent

    Student 1

    Age of student:
    What's their status? *

    How long has the student been studying? *

    Transfer students are required to have the consent of their current teachers to schedule a lesson. Do you have their current teacher's consent? *
    Yes, I have their current teacher's consent

    Add another student

    Student 2

    Age of student:
    What's their status? *

    How long has the student been studying? *

    Transfer students are required to have the consent of their current teachers to schedule a lesson. Do you have their current teacher's consent? *
    Yes, I have their current teacher's consent

    Add another student

    Student 3

    Age of student:
    What's their status? *

    How long has the student been studying? *

    Transfer students are required to have the consent of their current teachers to schedule a lesson. Do you have their current teacher's consent? *
    Yes, I have their current teacher's consent

    Add another student

    Student 4

    Age of student:
    What's their status? *

    How long has the student been studying? *

    Transfer students are required to have the consent of their current teachers to interview. Do you have their current teacher's consent? *
    Yes, I have their current teacher's consent

    List the days and times that would work for you on a regular weekly basis for lessons: *
    (Standard lessons are 60 minutes once a week. 45-minute lessons are an option for new beginners only, and 30-minute lessons are an option for beginners ages 5-6 only.)

    List specific dates and times when you would be available for an initial session: *
    (The initial session is the same length as a regular lesson, and will ideally be scheduled for the same day/time that you'd want for weekly lessons.)

    Use this space for additional information and/or questions:

    Before submitting, please double check that you've entered your e-mail address correctly! If I don't have a correct e-mail address, I can't contact you 🙂

    If you’re experiencing difficulty with the form, or have general questions, feel free to e-mail me at: stanek (at) pianowithjeff (dot) com. If you’re interested in scheduling an initial session, please put “Lesson Request” in the subject line, and include in the message your name, initial session availability, and weekly lesson availability in the e-mail, as well as helpful background information: ages of student(s) if not adult, status of student(s) (new beginner / transfer / resuming) and prior experience if any.