Inclusion Coaching Consultation Form

Inclusion Coaching Consultation Form
Welcome!

Our intention in creating this screening form is to get a sense of how we can support you and/or your organization through Inclusion Coaching.

If you are seeking therapy, testing or any other services, please head over to our website for further information:https://playfultherapy.net/contact
Name of Person Completing Form*
Phone Number*
Email Address*
Organization Name
Is your Organization a non-profit?*

YesNo
Organization Type*

AftercareSummer CampCampChildcareDaycarePreSchoolPublic SchoolPrivate SchoolReligious SchoolUnschooling Co-opHome School Co-opHospitalPediatric Dental Care TeamPediatric Medical Care TeamPediatric Mental Health Care TeamResidential HomePlace of WorshipExtracurricular ProgrammingScouting TroopMartial Arts StudioDrama, Music & Arts ProgramSwim SchoolGymnasticsSports CoachingOther
Ages Served by Organization*

InfantsToddlersPreSchoolersElementary SchoolersMiddle SchoolersHigh SchoolersYoung Adults (18-29)Middle Adults (30-64)Older Adults (65+)
When do you meet with the people you serve?

MorningsAfternoonsEveningsWeekdaysWeekends
Which of the following areas would you like to discuss including in your training?

Learning about common neurodivergent traitsBalancing the needs of an individual with the needs of the groupReducing staff burnoutDeveloping deeper understanding of what drives difficult behaviorsIncreasing effectiveness of responses to challenging behaviorsTransition supportsOther
How many people do you anticipate participating in the training?*

Less than 56 - 1011 - 2021 - 4041 - 100100+
Would you like to be scheduled as soon as possible or further out in the year?*

ASAPA future date. Month/Year:
Is your organization available for an initial, 2 hour training on a Thursday morning? (Start time will vary between 9:00 am and 10:00 am)*

YesYes, if scheduled in advanceNo
Should be Empty: