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Exit Survey
 
 
Name
   
 
 
Phone
   
 
 
Email Address
   
 
 
 
Are you currently accepting students?
 
Yes
 
No
 
 
When are you available to work with new students
   
 
 
 
PSA Rating
 
Level I
 
Level II
 
Level III
 
Level IV
 
Level V
 
Level VI
 
Level VII
 
Level VIII
 
Level IX
 
Level X

 
 
Degrees Awarded (Include Institution)
   
 
 
How many years have you been coaching? (Leave blank for less than one)
   
 
 
What is your rate for a 50 minute session?
   
 
 
 
What is your highest level passed in each of the following test series - Figures
 
Preliminary Figure
 
First Figure
 
Second Figure
 
Third Figure
 
Fourth Figure
 
Fifth Figure
 
Fifth Figure/Split
 
Sixth Figure
 
Sixth Figure/Split
 
Seventh Figure
 
Seventh Figure/Split
 
Eighth Figure
 
Eighth Figure/Split
 
Adult Bronze Figure
 
Adult Silver Figure
 
Adult Gold Figure