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First name
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Last name
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Email
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Address
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What is your first language?
Address
What other languages do you speak or study (if any)?
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What is your profession?
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How long have you been studying English?
1 year
1-3 years
3-7 years
7+ yrs
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When you speak English, what do you feel most often?
Nervous
Embarrassed
Afraid of mistakes
I understand but can’t respond
I translate in my head
I avoid speaking
I feel confident
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Have you ever felt that you “know English” but don’t sound like yourself when you speak?
Yes
No
I'm not sure
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When listening to native English speakers, what is hardest for you?
They speak too fast
Words sound connected
I know words but don’t recognize them
Pronunciation doesn’t match spelling
Accents confuse me
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Do you rely more on how words LOOK or SOUND when speaking English?
Mostly how they look
Mostly how they sound
I don’t know
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Why is it important for you to speak English confidently right now?
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Time Availability (I am located in Florida please check the time you will be available compared to New York Time
Morning (9 a.m. - 11 a.m.) New York EST
Afternoon (12 p.m.- 4 p.m.) New York EST
Evening (5 p.m. - 9 p.m.) New York EST
Thursday
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Which days are you available?
Monday
Tuesday
Wednesday
Thursday
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Are you open to learning English in a way that may feel a little uncomfortable at first but leads to faster, lasting confidence?
Yes, I think so
Not sure
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Access to Jasmin is limited and intentional. Which option best describes you right now?
I’m ready to invest in direct access and coaching
I want structured content first, then access
I’m not ready yet but want to learn
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The investment for this program is $599. Are you comfortable with this?
Yes
No
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