College Bound Group – Inquiry

College-Bound Group

Interested in joining this group and/or learning more?

Please complete the below information and we will reach out to you shortly.

Teen's Full Name

Age

School

Grade

Junior Senior

Parent/Guardian's Full Name

E-mail

Phone

Briefly describe the steps your teen has taken in the college application process:

Please list any current or suspected mental health diagnoses (e.g., Anxiety; Depression; ADHD; Learning Differences, etc.)

Is your teen currently in individual therapy?

Yes No

If so, are you comfortable sharing with your child's therapist the fact that he/she may participate in this therapy group?

Yes No Not applicable

What would you and/or your teen hope to get out of this group?

Is there any additional information you'd like to share with us?

How did you learn of this group?