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Expressions of Interest for PEERS® Adolescent Social Skills Program
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* Indicates required question
Is the adolescent currently aged between 12 - 18 years?
*
Choose
Yes
No - is aged 19 years or older
No - is currently aged 11 years or younger
Has the adolescent been diagnosed with, or do you suspect any of the following conditions (select all that apply)?
*
Autism Spectrum Disorder (ASD) / Asperger's Syndrome
Attention-deficit/hyperactivity disorder (ADHD)
Anxiety
Depression
Other
Required
Is the adolescent currently receiving funding via a National Disability Insurance Scheme (NDIS) plan?
Choose
Yes
No
Has the adolescent previously attended or is currently attending, any other social skills training? If so - please specify the trainer name and course title:
Your answer
Which locations would be convenient for you and the adolescent to attend training (please select all that apply)?
ONLINE
Perth - inner
Perth - western suburbs
Perth - eastern suburbs
Perth - northern suburbs
Perth - southern suburbs
Regional Perth (within 2 hours drive from CBD)
Other:
Which times would be most convenient for you and the adolescent to attend training?
Weekdays - mornings
Weekdays - afternoons - after school
Weekdays - evenings
Saturday - morning
Saturday - afternoon
Sunday - morning
Sunday - afternoon
Other:
To stay updated on upcoming training dates, please enter your full name and email address below:
*
Your answer
Thank you so much for taking the time to complete this form! I appreciate your support and will be in touch as soon as the program is open.
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