Group Referral for teens 13+ years of age.

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Complete this form to begin the group enrollment process.

*Once you have completed this form you will receive a text from Equity Associates outlining the next steps for finalizing group enrollment.

**All information on this form is confidential and will not be shared or distributed beyond internal use within Equity Associates.

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How did you hear about groups with Equity Associates?

School Name and Location *

Age of Participants

Middle School

High School

その他:

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School Contact Person (Name) *

School Contact Person (Phone Number) *

School Contact Person (Email Address) *

What are you looking for in a group experience for your student? (check all that apply)

learning skills for managing difficult emotions

reduced anxiety and or depression

improved relationships

increased capacity to manage stress

improved communication skills

increased confidence

improved social skills

その他:

What days of the week wouldn't ever work for a group meeting? *

Has the student participated in a counseling or mental health intervention group before? *

Yes

If you answered "yes" to above, tell us more about the group *

What else would you like us to know about the student as we prepare a group mental health intervention recommendation for the student? *

送信

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