YS_S4L SAS Expression of interest

Expression of Interest

Secret Agent Society
Client information
Name*

First NameLast Name
Date of birth*

DayMonthYear
Gender*
School name
What time does school finish?

Hour Minutes

AM/PM Option
Emergency contact information
Name*

First NameLast Name
Contact number*
Email*
example@example.com
Relationship*
How would you like to be contacted?*

PhoneMobileEmail
SAS Small group program components

SAS Small Group is a multi-component program that up-skills and empowers not only children with social and emotional challenges, but also the parents and teachers who support them. Child Group Meetings: delivered as 11-22 sessions of either 45 or 90 minutes. Parent Group Sessions: commence with a 2-hour parent information session, followed by 11-22 group meetings of 30-45 minutes, or 4 x 2-hour sessions, following child group meetings. School information sessions and teacher check-ins: 2-hours (optional)

Program structure preferences*

Do you and/or the participant have access to internet at your home?*

YesNoSometimesOther
Do you and/or the participant have access to a device larger than a smart phone?*

YesNoSometimesOther
Feedback: how did you hear about our program?*

AdvertisingReferralSocial MediaSAS websiteOther
Should be Empty:

Expression of Interest