Target Learning, LLC
REQUEST FOR A HOME-STUDY PERSONAL LEARNING PROGRAM

Name  

E-Mail Address 

Telephone     Ext.     Fax 

Street Address 

City     State     Zip  

Select a Program Title -----Custom Program----- OR --Target Reading --Target Writing --Target Memory --Target Thinking --Target Listening --Target Supervision --Target Study Skills
 

1.  If you chose "Custom Program", select the topics you want included:

Listening Skills
Memory Improvement
Business Writing
Business Grammar
Strategic Reading
Speed Reading
Critical Thinking
Creative Thinking
Management/Supervision Skills
Train the Trainer
Communication Skills
Public Speaking
Team Building
Customer Service
Study Skills
 

2.  List any specific learning objectives you would like to accomplish.

3.  What problems/issues (at work, school, or home) do you face that may require improved learning skills?

4.  Please list any special learning requirements, needs or considerations.

5.  If currently employed, what field do you currently work in?

Administration
Information Technology
Engineering
Accounting
Legal
Marketing/Sales
Customer Service
Operations
Manufacturing
Shipping/Receiving
Security
Construction
Other

6.  If in school, what grade are you currently in?

9th Grade
10th Grade
11th Grade
12th Grade
College Freshman
College Junior
College Sophomore
College Senior
College - Graduate Level

7.  If not in school, what was the highest grade level you completed?

9th Grade
10th Grade
11th Grade
12th Grade
College Freshman
College Junior
College Sophomore
College Senior
College - Graduate Level
College - Post Graduate Level

8.  When would you like to begin your Personal Learning Program?

Unknown at this time
February 2012
March 2012
April 2012
May 2012
June 2012
July 2012
August 2012
September 2012
October 2012
November 2012
December 2012