College Student ADHD Group Coaching — Interest Survey
Hey! Thanks for checking this out. This survey helps me figure out if this group is a good fit and how to set it up so it actually works for your life. Takes about 3-4 minutes. Be real with me — no wrong answers.
Let's start with the basics
Quick stuff first — who you are, contact, and when you're free.
Who's filling out this survey?
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The student
A parent / family member on behalf of the student
The student and a parent together
Student's name (first, last)
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First Name
Last Name
Student's email address (the one they actually check — not the school email if it gets ignored)
*
example@example.com
Student's phone number
Please enter a valid phone number.
Format: (000) 000-0000.
If a parent is filling this out, what's your name and best contact info? (Skip if the student is filling this out alone.)
Best way to reach the student about joining the group (be sure to leave your phone number above for call/text)
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Text
Email
Phone call
Is the student currently enrolled in college?
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Yes, Full-time
Yes, Part-time
Taking a semester off / on a break
Recently graduated
Other
What year?
Freshman
Sophomore
Junior
Senior
5th year +
Grad student
Not applicable
What days of the week work best? (select all that could work)
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Monday
Tuesday
Wednesday
Thursday
Friday
What time of day works best? (select all that could work)
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Late morning (10am-12pm)
Early afternoon (12pm-3pm)
Late afternoon (3pm-5pm)
Early evening (5pm-7pm)
Evening (7pm-9pm)
Back
Next
Let me know what's going on
This is the part that helps me figure out if this group is right for you.
What's the thing you're hoping group coaching will help with? (Examples: 'I can't start assignments until it's too late,' 'I'm failing a class and don't know how to recover,' 'I keep oversleeping and missing morning classes.')
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What best describes the student right now? (select all that apply)
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Diagnosed with ADHD
Self-identified / suspect ADHD
On medication for ADHD
Not on medication
Living on campus
Living off campus / commuting
Working a job alongside school
Involved in clubs/sports/Greek life/etc.
First in family to go to college
Struggling academically right now
Doing okay academically but burning out
Feeling good
Not sure what to expect this semester
Other
Has the student worked with a coach, therapist, tutor, or academic advisor before? What helped or didn't? (Helps me know what you're comparing this to.)
Describe your ideal group coaching setup.
What would make this a 'yes'? (Or flip it — what's making you hesitant? Cost, time, 'I've tried stuff before and it didn't work,' fear of group settings — whatever it is, tell me.)
Who's involved in the decision to join?
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The student is deciding on their own
Parent / family is paying or helping pay
Parent suggested it but the student is deciding
It's a joint decision
Other
Back
Next
You made it — last page
Almost done — just a couple quick ones.
Where did you learn about this group? (Be specific — which Facebook group, who told you, what professor, etc.)
*
Anything else you want me to know? (Optional.)
Submit
Should be Empty: