Changing the Mindset Service Request Form
Please review the form below and complete based on your personal and organizational needs. All consultations are free! Please email with any questions or concerns: info@changingthemindset.org
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Organization Name
*
Organization's Address (If you would like in-person services.)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What services are you seeking?
*
Individual Session
Group Session (calendar of events will be emailed to you)
Leadership Coaching, Consulting or Mentoring
Team Building for your organization
Speaking or Professional Development Workshop
Individual Services
Please identify if you are interested in individual sessions (as related to work related issues, i.e. bullying, workplace stress, trauma, self-care, etc.) and/or leadership coaching, mentoring and consulting needs. We will discuss more in detail.
For individual sessions and leadership coaching, mentoring or consulting, someone from the team will contact you to schedule a consultation and gather more information. Please provide your issues and/or needs here.
Team Building Activities
Please identify the issues and concerns that you would like to enhance. Example, communication, workplace culture, leadership and also tell us more about the staffing that will be present (i.e. human resource department, home visitors, all staff)
For team building, someone from the team will contact you to schedule a consultation and gather more information. Please provide your issues and/or needs here.
Speaking and Professional Development Opportunities
Dr. Shmeka Gibson is available for public speaking and keynote address. Please list that in the description below. We offer many workshops for staffing development please see a list of the workshops. If you do not see a professional development desire listed, please add it in the description below and we will let you know if it's a workshop we can complete. •Motivational Interviewing •Workplace Trauma •ACE (Adverse Childhood Experiences) •Motivational Leadership• Other Topics Centered around Changing the Mindset •Safety in the Workplace
For speaking or professional development workshops, someone from the team will contact you to schedule a consultation and to gather more information. Please provide your issues and/or needs here.
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