diff --git a/site/src/components/Stack/Stack.tsx b/site/src/components/Stack/Stack.tsx
index de9bacede3f73..97bb40538617c 100644
--- a/site/src/components/Stack/Stack.tsx
+++ b/site/src/components/Stack/Stack.tsx
@@ -1,11 +1,12 @@
 import { makeStyles } from "@material-ui/core/styles"
 import React from "react"
+import { combineClasses } from "../../util/combineClasses"
 
 type Direction = "column" | "row"
 
 interface StyleProps {
-  spacing: number
   direction: Direction
+  spacing: number
 }
 
 const useStyles = makeStyles((theme) => ({
@@ -17,11 +18,13 @@ const useStyles = makeStyles((theme) => ({
 }))
 
 export interface StackProps {
-  spacing?: number
+  className?: string
   direction?: Direction
+  spacing?: number
 }
 
-export const Stack: React.FC<StackProps> = ({ children, spacing = 2, direction = "column" }) => {
+export const Stack: React.FC<StackProps> = ({ children, className, direction = "column", spacing = 2 }) => {
   const styles = useStyles({ spacing, direction })
-  return <div className={styles.stack}>{children}</div>
+
+  return <div className={combineClasses([styles.stack, className])}>{children}</div>
 }
diff --git a/site/src/components/WorkspaceStats/WorkspaceScheduleForm.stories.tsx b/site/src/components/WorkspaceStats/WorkspaceScheduleForm.stories.tsx
new file mode 100644
index 0000000000000..74fc7b921ce75
--- /dev/null
+++ b/site/src/components/WorkspaceStats/WorkspaceScheduleForm.stories.tsx
@@ -0,0 +1,20 @@
+import { action } from "@storybook/addon-actions"
+import { Story } from "@storybook/react"
+import React from "react"
+import { WorkspaceScheduleForm, WorkspaceScheduleFormProps } from "./WorkspaceScheduleForm"
+
+export default {
+  title: "components/WorkspaceScheduleForm",
+  component: WorkspaceScheduleForm,
+}
+
+const Template: Story<WorkspaceScheduleFormProps> = (args) => <WorkspaceScheduleForm {...args} />
+
+export const Example = Template.bind({})
+Example.args = {
+  onCancel: () => action("onCancel"),
+  onSubmit: () => {
+    action("onSubmit")
+    return Promise.resolve()
+  },
+}
diff --git a/site/src/components/WorkspaceStats/WorkspaceScheduleForm.test.ts b/site/src/components/WorkspaceStats/WorkspaceScheduleForm.test.ts
new file mode 100644
index 0000000000000..cdd133dfc7932
--- /dev/null
+++ b/site/src/components/WorkspaceStats/WorkspaceScheduleForm.test.ts
@@ -0,0 +1,57 @@
+import { Language, validationSchema, WorkspaceScheduleFormValues } from "./WorkspaceScheduleForm"
+
+const valid: WorkspaceScheduleFormValues = {
+  sunday: false,
+  monday: true,
+  tuesday: true,
+  wednesday: true,
+  thursday: true,
+  friday: true,
+  saturday: false,
+
+  startTime: "09:30",
+  ttl: 120,
+}
+
+describe("validationSchema", () => {
+  it("allows everything to be falsy", () => {
+    const values: WorkspaceScheduleFormValues = {
+      sunday: false,
+      monday: false,
+      tuesday: false,
+      wednesday: false,
+      thursday: false,
+      friday: false,
+      saturday: false,
+
+      startTime: "",
+      ttl: 0,
+    }
+    const validate = () => validationSchema.validateSync(values)
+    expect(validate).not.toThrow()
+  })
+
+  it("disallows ttl to be negative", () => {
+    const values = {
+      ...valid,
+      ttl: -1,
+    }
+    const validate = () => validationSchema.validateSync(values)
+    expect(validate).toThrow()
+  })
+
+  it("disallows all days-of-week to be false when startTime is set", () => {
+    const values = {
+      ...valid,
+      sunday: false,
+      monday: false,
+      tuesday: false,
+      wednesday: false,
+      thursday: false,
+      friday: false,
+      saturday: false,
+    }
+    const validate = () => validationSchema.validateSync(values)
+    expect(validate).toThrowError(Language.errorNoDayOfWeek)
+  })
+})
diff --git a/site/src/components/WorkspaceStats/WorkspaceScheduleForm.tsx b/site/src/components/WorkspaceStats/WorkspaceScheduleForm.tsx
new file mode 100644
index 0000000000000..1603e28e7e8e1
--- /dev/null
+++ b/site/src/components/WorkspaceStats/WorkspaceScheduleForm.tsx
@@ -0,0 +1,233 @@
+import Checkbox from "@material-ui/core/Checkbox"
+import FormControl from "@material-ui/core/FormControl"
+import FormControlLabel from "@material-ui/core/FormControlLabel"
+import FormGroup from "@material-ui/core/FormGroup"
+import FormHelperText from "@material-ui/core/FormHelperText"
+import FormLabel from "@material-ui/core/FormLabel"
+import makeStyles from "@material-ui/core/styles/makeStyles"
+import TextField from "@material-ui/core/TextField"
+import { useFormik } from "formik"
+import React from "react"
+import * as Yup from "yup"
+import { getFormHelpers } from "../../util/formUtils"
+import { FormFooter } from "../FormFooter/FormFooter"
+import { FullPageForm } from "../FullPageForm/FullPageForm"
+import { Stack } from "../Stack/Stack"
+
+export const Language = {
+  errorNoDayOfWeek: "Must set at least one day of week",
+  daysOfWeekLabel: "Days of Week",
+  daySundayLabel: "Sunday",
+  dayMondayLabel: "Monday",
+  dayTuesdayLabel: "Tuesday",
+  dayWednesdayLabel: "Wednesday",
+  dayThursdayLabel: "Thursday",
+  dayFridayLabel: "Friday",
+  daySaturdayLabel: "Saturday",
+  startTimeLabel: "Start time",
+  startTimeHelperText: "Your workspace will automatically start at this time.",
+  ttlLabel: "Runtime (minutes)",
+  ttlHelperText: "Your workspace will automatically shutdown after the runtime.",
+}
+
+export interface WorkspaceScheduleFormProps {
+  onCancel: () => void
+  onSubmit: (values: WorkspaceScheduleFormValues) => Promise<void>
+}
+
+export interface WorkspaceScheduleFormValues {
+  sunday: boolean
+  monday: boolean
+  tuesday: boolean
+  wednesday: boolean
+  thursday: boolean
+  friday: boolean
+  saturday: boolean
+
+  startTime: string
+  ttl: number
+}
+
+export const validationSchema = Yup.object({
+  sunday: Yup.boolean(),
+  monday: Yup.boolean().test("at-least-one-day", Language.errorNoDayOfWeek, function (value) {
+    const parent = this.parent as WorkspaceScheduleFormValues
+
+    if (!parent.startTime) {
+      return true
+    } else {
+      return ![
+        parent.sunday,
+        value,
+        parent.tuesday,
+        parent.wednesday,
+        parent.thursday,
+        parent.friday,
+        parent.saturday,
+      ].every((day) => day === false)
+    }
+  }),
+  tuesday: Yup.boolean(),
+  wednesday: Yup.boolean(),
+  thursday: Yup.boolean(),
+  friday: Yup.boolean(),
+  saturday: Yup.boolean(),
+
+  startTime: Yup.string(),
+  ttl: Yup.number().min(0).integer(),
+})
+
+export const WorkspaceScheduleForm: React.FC<WorkspaceScheduleFormProps> = ({ onCancel, onSubmit }) => {
+  const styles = useStyles()
+
+  const form = useFormik<WorkspaceScheduleFormValues>({
+    initialValues: {
+      sunday: false,
+      monday: true,
+      tuesday: true,
+      wednesday: true,
+      thursday: true,
+      friday: true,
+      saturday: false,
+
+      startTime: "09:30",
+      ttl: 120,
+    },
+    onSubmit,
+    validationSchema,
+  })
+  const formHelpers = getFormHelpers<WorkspaceScheduleFormValues>(form)
+
+  return (
+    <FullPageForm onCancel={onCancel} title="Workspace Schedule">
+      <form className={styles.form} onSubmit={form.handleSubmit}>
+        <Stack className={styles.stack}>
+          <TextField
+            {...formHelpers("startTime", Language.startTimeHelperText)}
+            InputLabelProps={{
+              shrink: true,
+            }}
+            label={Language.startTimeLabel}
+            type="time"
+            variant="standard"
+          />
+
+          <FormControl component="fieldset" error={Boolean(form.errors.monday)}>
+            <FormLabel className={styles.daysOfWeekLabel} component="legend">
+              {Language.daysOfWeekLabel}
+            </FormLabel>
+
+            <FormGroup>
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.sunday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="sunday"
+                  />
+                }
+                label={Language.daySundayLabel}
+              />
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.monday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="monday"
+                  />
+                }
+                label={Language.dayMondayLabel}
+              />
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.tuesday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="tuesday"
+                  />
+                }
+                label={Language.dayTuesdayLabel}
+              />
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.wednesday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="wednesday"
+                  />
+                }
+                label={Language.dayWednesdayLabel}
+              />
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.thursday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="thursday"
+                  />
+                }
+                label={Language.dayThursdayLabel}
+              />
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.friday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="friday"
+                  />
+                }
+                label={Language.dayFridayLabel}
+              />
+              <FormControlLabel
+                control={
+                  <Checkbox
+                    checked={form.values.saturday}
+                    disabled={!form.values.startTime}
+                    onChange={form.handleChange}
+                    name="saturday"
+                  />
+                }
+                label={Language.daySaturdayLabel}
+              />
+            </FormGroup>
+            {form.errors.monday && <FormHelperText>{Language.errorNoDayOfWeek}</FormHelperText>}
+          </FormControl>
+
+          <TextField
+            {...formHelpers("ttl", Language.ttlHelperText)}
+            inputProps={{ min: 0, step: 30 }}
+            label={Language.ttlLabel}
+            type="number"
+            variant="standard"
+          />
+
+          <FormFooter onCancel={onCancel} isLoading={form.isSubmitting} />
+        </Stack>
+      </form>
+    </FullPageForm>
+  )
+}
+
+const useStyles = makeStyles({
+  form: {
+    display: "flex",
+    justifyContent: "center",
+  },
+  stack: {
+    // REMARK: 360 is 'arbitrary' in that it gives the helper text enough room
+    //         to render on one line. If we change the text, we might want to
+    //         adjust these. Without constraining the width, the date picker
+    //         and number inputs aren't visually appealing or maximally usable.
+    maxWidth: 360,
+    minWidth: 360,
+  },
+  daysOfWeekLabel: {
+    fontSize: 12,
+  },
+})
diff --git a/site/src/util/formUtils.ts b/site/src/util/formUtils.ts
index da5d1b6b87a78..eec487f70ca15 100644
--- a/site/src/util/formUtils.ts
+++ b/site/src/util/formUtils.ts
@@ -28,7 +28,7 @@ export const getFormHelpers =
       ...form.getFieldProps(name),
       id: name,
       error: touched && Boolean(error),
-      helperText: touched ? error : helperText,
+      helperText: touched ? error || helperText : helperText,
     }
   }