Songwriting Lessons Request Form Student Name * First Name Last Name Student Age * Email * Phone (###) ### #### Closest City/Town * Primary Instrument * Are you proficient with playing basic chords on your instrument? Select from drop down Yes No Some experience What are you most excited to learn about? Check as many as you want! Lyric Writing Song Form Recording/Production Developing Style Music Theory in Songwriting Unsure Preferred location for lessons Home (I'd prefer you travel to me) Studio (near Cohoes, NY) Other (e.g. public practice rooms) Doesn't matter Any other questions or thoughts? Thanks for reaching out! Songwriting is such a great expressive tool, and I’m looking forward to helping you get the most out of it!