Qualifying Questionnaire
Before booking a 15-minute Parent Intro Call, we ask you to complete this quick questionnaire so we can confirm fit and direct you to the right next step.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
1) What grade is your child in right now?
*
Please Select
4th
5th
6th
7th
8th
9th+
2) What made you start looking for support like SEEDS right now? (Choose up to 3)
*
Confidence/self-trust is low
Struggles with decision-making / freezes / overthinks
Communication issues (shuts down, attitude, won’t speak up)
Friendship/social stress or conflict
Bullying (being bullied or acting like the bully)
Transition coming up (middle school / high school choice)
Other
3) If SEEDS worked perfectly in 120 days, what would you notice is different? (Pick 2–3)
*
Speaks up with less fear
Handles conflict/pressure better
Stronger sense of identity (“steady in who I am”)
Makes decisions with more confidence
Healthier friendships / better social choices
Better communication at home
Other
4) How does your child typically do in small group learning environments?
*
Loves groups / participates easily
Warms up after a few sessions
Shy but willing
Often refuses / disrupts / won’t engage
Not sure yet
5) Important: SEEDS is not therapy. Are any of these currently true? (Check all that apply)
*
Active self-harm threats or recent self-harm
Violence/aggression that feels unsafe in a group
Current psychiatric crisis / hospitalization risk
Severe depression/anxiety that is not being treated
None of the above
6) Does your child tend to “take up the room” (dominates, argues, derails, needs constant 1:1 redirection)?
*
Often
Sometimes
Rarely
Not sure
7) SEEDS works best when the parent is aligned and reinforces at home. Which feels most true?
*
I’m ready to support and reinforce what my child is learning
I’m open, but I’ll need guidance
I’m skeptical / need to be convinced
I mostly want someone to “fix” my child
8) Is your child a leader
*
Please Select
Yes
No
Sometimes
9) Enrollment includes a parent book and a personality assessment as part of the setup/registration. Are you willing to complete those steps?
*
Please Select
Yes
Maybe — I need to understand why
No
10) SEEDS requires consistent participation to work. Our program also requires a 4 month commitment to ensure our promise can be delivered. Can your child attend weekly sessions for at least the next 16 weeks?
*
Please Select
Yes
Mostly (some conflicts)
No / unpredictable schedule
11) What is your timeline for getting support in place?
*
Please Select
This week
Within 2–4 weeks
1–2 months
Just exploring / not sure
Submit
Should be Empty: