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Intake form
Help us serve you better
Name
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Email address
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What age group do you belong to?
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Under 18
18-24
25-34
35-44
45-54
55-64
65 and older
What topics are you most interested in learning about?
Please select at least one option.
Avoiding scams
Escape techniques for dangerous situations
Dealing with corrupt systems
Identity protection
Financial literacy
Emergency preparedness
Self-defense
Conflict resolution
How did you hear about street smarts academy?
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Social media
Friend or family
Search engine
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Event or workshop
What is your preferred method of learning?
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Online courses
In-person workshops
Webinars
One-on-one coaching
Group classes
What specific skills do you wish to develop?
Which service or services are you interested in?
Please select at least one option.
Scam avoidance training
Escape tactics workshop
Identity protection essentials
Initial consultation for $150
Follow-up consultation for $100
Additional questions or comments
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