Expression of Interest

Name of Organization/Individual

Contact Person (if applicable)

Email Address

Phone Number

Role/Position

Please indicate which service(s) you are interested in:

Corporate Talks

School-wide Intervention

Group Programs

Supervision

Briefly describe your interest in the selected service(s):

If interested in Corporate Talks, please provide additional information:

Number of Participants Expected:

Preferred Topics or Areas of Focus:

Preferred Date(s) and Time(s) for the Talk

If interested in School-wide Intervention, please provide additional information:

Name of School/Institution

Description of Current Challenges or Needs

Number of Students/Participants

Preferred Approach (e.g., Workshops, Training Sessions, etc.)

Preferred frequency of intervention sessions - regular, once off, group or individually

Preferred dates for session/s

If interested in Group Programs, please provide additional information:

Parent Programs Includes: 1-2-3 Magic and Emotion Coaching Parenting program, and Living with ADHD: Helping your child apply the brakes

Children's programs include: Zones of Regulation, Cool kids anxiety program

Adolescent programs include: Acing Anxiety (teens), HSC Study without stress (teens)

How many people interested to attend sesison

If interested in Supervision, please provide additional information:

Area(s) of Supervision Needed (e.g., Clinical, Educational, etc.):

University studying at, etc.. (narmi add relevant questions or to deal with individually via email)