Center For Trauma Care in Schools: Group Registration
This form is used for the purpose of helping us collect information about the groups, so we know who is leading a group to ensure you have the support you need.  No student-level information will be collected.

If you are running more than one group, please fill out a form for each group.

Once you submit the form, Lisa Baron will reach out to you to offer additional support.

If you have any questions, feel free to reach out to your supervisor, or to us directly at lbaron@aipinc.org
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Name of Group Leader *
Group Leader Employer *
Group Leader Email Address *
Group Leader Phone # *
School District in Which the Group is Run *
Name of School in Which the Group is Run *
Name of Group Co-Leader (if any)
Co-Leader Employer
Co-Leader Email Address
Co-Leader Phone Number
GROUP INFORMATION
Total Number of Students Participating in Group *
Total Number of Students Screened (including students who did not receive group treatment) *
Type of Group *
Group Start Date *
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