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request.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta name="description" content="Request a coach today! We will get back to you with a qualified coach,
who can help you with whatever your learning goal is, within 24 hours.">
<meta name="keywords" content="coaching, tutoring, private, tutor, learn, science, math, engineering, technology, stem, homework,
project, project, test, exam, preparation, help, advance, mastery, ahead">
<meta name="author" content="Avery Lieu">
<title>Request a Coach</title>
<!-- Bootstrap Core CSS -->
<link href="css/bootstrap.min.css" rel="stylesheet">
<!-- Custom CSS -->
<link href="css/landing-page.css" rel="stylesheet">
<link href="css/request-page.css" rel="stylesheet">
<!-- Custom Fonts -->
<link href="font-awesome/css/font-awesome.min.css" rel="stylesheet" type="text/css">
<link href="https://fonts.googleapis.com/css?family=Lato:300,400,700,300italic,400italic,700italic" rel="stylesheet" type="text/css">
<!-- Metadata -->
<script type="application/ld+json">
{
"@context": "http://schema.org",
"@type": "WebSite",
"url": "https://pstemcoaching.com/request",
"author": {
"@type": "Organization",
"name": "Private STEM Coaching",
"email": "requests@pstemcoaching.com"
},
"datePublished": "2017-01-14",
"description": "Request a coach today! We will get back to you with a qualified coach, who can help you with whatever your learning goal is, within 24 hours.",
"copyrightHolder": {
"@type": "Organization",
"name": "Private STEM Coaching"
},
"copyrightYear": "2017"
}
</script>
</head>
<body>
<!-- Navigation -->
<nav class="navbar navbar-default navbar-fixed-top topnav" role="navigation">
<div class="container topnav">
<!-- Brand and toggle get grouped for better mobile display -->
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#bs-example-navbar-collapse-1">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand topnav" href="index">Home</a>
</div>
<!-- Collect the nav links, forms, and other content for toggling -->
<div class="collapse navbar-collapse" id="bs-example-navbar-collapse-1">
<ul class="nav navbar-nav navbar-right">
<li>
<a class="selected-tab">Request a Coach</a>
</li>
<li>
<a href="coaches">Our Coaches</a>
</li>
<li>
<a href="index#about">About</a>
</li>
<li>
<a href="index#services">Services</a>
</li>
<li>
<a href="index#contact">Contact</a>
</li>
</ul>
</div>
<!-- /.navbar-collapse -->
</div>
<!-- /.container -->
</nav>
<div class="container">
<div class="request-section">
<h1>Request a Coach</h1>
<hr class="section-heading-spacer">
<div class="clearfix"></div>
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-12">
<form class="request-form" id="request-form" onsubmit="return submitRequest()" method="POST">
<input type="hidden" name="_next" value="index">
<input type="text" name="_gotcha" class="hidden-input">
<input type="hidden" name="_cc" value="7qpvxrk0@robot.zapier.com">
<div class="form-group first-name-field col-lg-6 col-md-6 col-sm-6 col-xs-6">
<label for="first-name" class="name-label">First Name</label>
<label for="first-name" class="error-label error-label-name" id="error-label-first-name">*</label>
<input type="text" name="first-name" class="form-control" id="first-name" placeholder="Enter first name">
</div>
<div class="form-group last-name-field col-lg-6 col-md-6 col-sm-6 col-xs-6">
<label for="last-name" class="name-label">Last Name</label>
<label for="last-name" class="error-label error-label-name" id="error-label-last-name">*</label>
<input type="text" name="last-name" class="form-control" id="last-name" placeholder="Enter last name">
</div>
<div class="form-group">
<label for="sender-email">Your Email Address</label>
<label for="sender-email" class="error-label" id="error-label-email">*</label>
<input type="email" name="email" class="form-control" id="sender-email" placeholder="Enter email">
</div>
<div class="form-group">
<label>Payment Method</label>
<label class="error-label" id="error-label-payment-method">*</label>
<div class="row">
<div class="col-lg-8 col-md-8 col-sm-8 col-xs-10">
<div class="row">
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-6">
<label for="payment-method-1" class="form-check-label payment-button">
<input type="radio" onclick="validPaymentMethod()" name="payment-method" class="form-check-input" id="payment-method-1" value="$">
Square Cash
</label>
</div>
<div class="col-lg-6 col-md-6 col-sm-6 col-xs-6">
<label for="payment-method-2" class="form-check-label payment-button">
<input type="radio" onclick="validPaymentMethod()" name="payment-method" class="form-check-input" id="payment-method-2" value="@">
Venmo
</label>
</div>
</div>
</div>
</div>
<label for="payment-username" class="payment-username-label" id="payment-username-label"></label>
<label for="payment-username" class="error-label payment-username-label" id="error-label-payment-username">*</label>
<input type="hidden" name="payment-username" class="form-control" id="payment-username">
</div>
<div class="form-group">
<label for="topic">Subject</label>
<label for="topic" class="error-label" id="error-label-subject">*</label>
<input type="text" name="subject" class="form-control" id="topic" placeholder="Enter subject">
</div>
<div class="form-group">
<input type="hidden" name="_subject" id="_subject">
<label for="service">Service</label>
<label for="service" class="error-label" id="error-label-service">*</label>
<select name="service" class="form-control" id="service">
<option value="" disabled selected>Select a service</option>
<option value="Homework/Project Help">Homework/Project Help</option>
<option value="Test Preparation">Test Preparation</option>
<option value="Getting Ahead/Skill Mastery">Getting Ahead/Skill Mastery</option>
</select>
</div>
<div class="form-group">
<label for="coach-selection">Coach</label>
<select name="coach" class="form-control" id="coach-selection">
<option value="" disabled selected>Select a coach</option>
<option value="Kevin K.">Kevin K.</option>
<option value="Owen K.">Owen K.</option>
<option value="Avery L.">Avery L.</option>
<option value="Ciera S.">Ciera S.</option>
<option value="Jason S.">Jason S.</option>
</select>
</div>
<div class="form-group">
<label for="message">Additional information</label>
<textarea name="message" class="form-control" id="message" rows="10" placeholder="Type your message..."></textarea>
</div>
<button type="submit" class="btn btn-primary submit-button">Send</button>
</form>
</div>
<div class="col-lg-5 col-lg-offset-1 col-md-5 col-md-offset-1 col-sm-5 col-sm-offset-1 col-xs-12">
<p class="lead request-instructions first-paragraph">
Let us know how our coaches can help you by filling out our request form (required sections marked with
<p class="lead inline-asterisk">*</p>
<p class="lead request-instructions">), and we will get back to you within 24 hours.</p>
</p>
<p class="lead request-instructions">
Most lessons are done online through Skype or Google Hangouts, but depending on your location and preferences
we may be able to accomodate in-person sessions.
</p>
<p class="lead disclaimer">
**Rates are generally between $30-60/hour but may vary.
</p>
</div>
<div class="clearfix"></div>
</div>
</div>
</div>
<!-- /.content-section-a -->
<a name="contact"></a>
<div class="banner">
<div class="container">
<div class="row">
<div class="col-lg-6">
<h2>Connect with Us:</h2>
</div>
<div class="col-lg-6">
<ul class="list-inline banner-social-buttons">
<li>
<a href="https://twitter.com/pstemcoaching" target="_blank" class="btn btn-default btn-lg"><i class="fa fa-twitter fa-fw"></i> <span class="network-name">Twitter</span></a>
</li>
<li>
<a href="https://www.facebook.com/pstemcoaching/" target="_blank" class="btn btn-default btn-lg"><i class="fa fa-facebook fa-fw"></i> <span class="network-name">Facebook</span></a>
</li>
<li>
<a href="https://www.linkedin.com/company/private-stem-coaching?trk=biz-companies-cym" target="_blank" class="btn btn-default btn-lg">
<i class="fa fa-linkedin fa-fw"></i> <span class="network-name">Linkedin</span>
</a>
</li>
</ul>
</div>
</div>
</div>
<!-- /.container -->
</div>
<!-- /.banner -->
<!-- Footer -->
<footer>
<div class="container">
<div class="row">
<div class="col-lg-12">
<ul class="list-inline">
<li>
<a href="index">Home</a>
</li>
<li class="footer-menu-divider">⋅</li>
<li>
<a class="selected-tab">Request a Coach</a>
</li>
<li class="footer-menu-divider">⋅</li>
<li>
<a href="coaches">Our Coaches</a>
</li>
<li class="footer-menu-divider">⋅</li>
<li>
<a href="index#about">About</a>
</li>
<li class="footer-menu-divider">⋅</li>
<li>
<a href="index#services">Services</a>
</li>
<li class="footer-menu-divider">⋅</li>
<li>
<a href="index#contact">Contact</a>
</li>
</ul>
<p class="copyright text-muted small">© Private STEM Coaching 2017. All Rights Reserved</p>
</div>
</div>
</div>
</footer>
<!-- jQuery -->
<script src="js/jquery.js"></script>
<!-- Bootstrap Core JavaScript -->
<script src="js/bootstrap.min.js"></script>
<!-- Custom JavaScript -->
<script type="text/javascript" src="js/form-validation.js"></script>
<script type="text/javascript" src="js/request-page.js"></script>
<!-- Site Analytics -->
<script src="//static.getclicky.com/js" type="text/javascript"></script>
<script type="text/javascript">try{ clicky.init(101019265); }catch(e){}</script>
<noscript><p><img alt="Clicky" width="1" height="1" src="//in.getclicky.com/101019265ns.gif" /></p></noscript>
</body>
</html>