Psychoeducational Seminar or Training Request Form

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Thank you for contacting Youthful Connections, Coaching Consultations, and Counseling PLLC for your needs and services. Dismantling the stigma of mental health and empowering African American individuals and families with knowledge and tools to combat generational myths is our focus. Therefore, please complete the form below to make your request for services. After you fill out this request, we will contact you to go over details, pricing, and availability within 72 hours. If you have not received any contact within that timeframe, please contact Janiqua Obey, MSW LCSW at yccoaching2022@gmail.com. Have a great day!

Name of individual completing form? *

Name of company/agency/organization requesting psychoeducational seminar or training? *

Phone number *

E-mail *

Physical address? (complete with street, city, state, and zip code) *

What topic are you seeking further education? (i.e depression in adolescents, etc.) *

Audience size? (number estimate) *

Face to face or Virtual presentation? *

Face to Face

Virtual

Length of time requesting for seminar or training? (1 hour minimum) *

Please provide further comments regarding needs as it relates to the seminar or training. *

Submit

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