L.I.T.T. Teen Coaching Intake – Parent/Guardian Assessment (Ages 12-19)

L.I.T.T. Teen Coaching Intake – Parent/Guardian Assessment (Ages 12-19)
Customized 1:1 Coaching Experience for Your Youth

Welcome! The goal of this assessment is to help me design a customized L.I.T.T. (Life • Identity • Training & Transformation) 1-on-1 Coaching Experience that meets your youth exactly where they are right now. Because trust is everything in mentorship, my sessions with your youth will remain confidential, but I will keep you in the loop with brief progress summaries every few weeks. Please answer the questions below honestly—there are no right or wrong answers and no judgment. Your insight is the first step in building the most supportive action plan possible for them.
- Parent/Guardian Full Name
- Parent/Guardian Email
- Parent/Guardian Phone Number
- Youth Full Name
- Youth Pronouns?
- Youth Age
- Youth Grade Level
- Date of Submission
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Areas of Concern (Check all that apply)
  
  Other
- Checkboxes only tell part of the story. Please expand on the concerns you selected above. Are there any specific incidents, patterns, or recent changes in their behavior that prompted you to seek additional support at this time? ?
- Section 3: Goals & Support (The Path Forward): Why we ask this: To define exactly what a successful coaching experience looks like for your family, and to ensure I am aware of any important background information so I can best support your youth.
- What are the top three things you’d like your youth to gain from coaching/mentoring?
- How would you describe your youth's current behavior, attitude, and mood on most days?
- Has your youth had any previous counseling, mentoring, or support programs?
- Are there any triggers, safety concerns, or sensitivities I should be aware of?
- What type of learning or coaching style do you think your teen responds best to?
  
  Other
- Why we ask this: Every L.I.T.T. mentorship begins with our mandatory core foundation: Discovering their Identity, building a 1-Year Future Vision, and auditing their "Circle of Influence" (navigating peer pressure). This section helps me customize the rest of the program to target the specific skills your youth needs most. (Select up to 4):
- What level of parent involvement feels most comfortable for you?
  
  Other
- Are you open to a brief parent reflection monthly?
- Is there anything else you’d like Alexis to know about your youth, your home dynamic, or your hopes for this program?
- What does your youths weekly schedule look like? Please include school hours, after-school activities, sports, religious programs, work shifts, or any other regular commitments. This helps me plan sessions around your teen’s routine and make sure we’re setting them up for success.
- Let's Connect! (Next Steps) Once I review this assessment, I will put together a customized coaching recommendation for your youth. What are 2 or 3 days and times next week that work for a quick 10-15 minute phone call to discuss the plan?
- Should be Empty:

L.I.T.T. Teen Coaching Intake – Parent/Guardian Assessment (Ages 12-19)

Customized 1:1 Coaching Experience for Your Youth