Groups Winter 2026

Welcome to CORE Connection Counseling

Group Pre-Registration Form

6040 State Route 53, Suite C
Lisle, IL 60532
P: 630-524-4000 / F: 630-524-2311

www.coreconnectioncc.com

Shawn Amador, LCSW

Jessica Amedeo, LCSW

Courtney Brown, LCSW

Kelly DeAngelo, LCSW

Colleen Hanson, LCSW

Janell Larson, LCSW

Jaclyn, Schramm, LCSW

Dana Sutton, LCSW

Jamie Wiora, LCSW

Thank you for your interest in our groups!!

When forming our groups, we consider the social understanding, social skills and emotional functioning level (in addition to chronological age and grade level) to place children/teens/young adults in groups that are matched well and working at similar skill levels. An intake session is completed prior to finalzing placement in a group.

Please note, some groups are self pay only/educational groups (not eligible to bill insurance).
Therapeutic groups can be submitted to insurance for reimbursement.

We are in network with Blue Cross Blue Shield PPO, Blue Choice, Blue Cross HPN, and Aetna

Social-Emotional Groups are typically offered by semester: Fall, Winter/Spring, and Summer.
Winter Groups 2026

Choose the group below:
For Middle School/Jr. High

Junior High School Social Theatre
Client Name*

FirstMiddleLast
Date of Birth:*
Gender*
Client Address:*

Street Address

Apartment/Unit Number

CityState

Postal / Zip Code
If Client is a student: Grade Level for 2025/2026 school year:
Options: Elementary through High School only. If no option applies, select Other
New or Current Client:*

Yes - new clientNo - current or past client
Diagnosis, health conditions, medications, allergies and/or special diets?
240 Character Max
Primary Contact Name:*
Primary Cellular Phone #:*

Area CodePhone Number
Primary Contact's Email *
example@example.com
EDUCATION INFORMATION School Name and District: (n/a if not in school)*
Does the client have an IEP or 504 Plan? *
Classroom Placement:*

General EducationResource RoomSelf Contained ClassroomHomeschoolTherapeutic SchoolNone ApplyOther
Current Services Received (select all that apply):
Please list classes or subjects client does best in academically:
Please list classes or subjects client academically struggles with most:
Please describe personal strengths, area(s) of interest, and extracurricular activities:*
Please provide your concerns regarding emotional, social, behavioral functioning at home, school, work and/or in the community:*
Please describe relationships and interactions with family, peers, adults and others at school, in activities, community, work and/or other settings:*
Briefly describe 3 social and/or emotional goals and/or how you hope this group will benefit the participant? *
1)
2)
3)
Please tell us how you found out about our office or heard about our social/emotional groups:*
Name of Referral Source:
Questions or additional information to share?
Insurance:*

Blue Cross Blue Shield PPO, Blue Choice, Blue Cross HPN-In NetworkAetnaOther Insurance submit claims as a courtesySelf-Pay
Yes, sign us up for the CORE Connection News email list to receive updates on new groups and other practice information. (We promise not to spam you)

YesNo, thanks
Email
example@example.com
Should be Empty:

Winter Groups 2026