TeenLife Website Listing Creation Form

IECA Member Listings Upgrade Request
IECA Professional Members in good standing are invited to submit this form and receive a complimentary upgraded Premium listing on TeenLife.com for 12 months. Questions? Contact support@teenlife.com.
Name of Professional IECA Member

First NameLast Name
Email Address
This also serves as your UserID for logging in to TeenLife.com. It is not visible on your listing.
Do you already have a listing on TeenLife.com?

YesNoNot sure
Listing Details
Listing Name as you would like it to appear on TeenLife.com:
Website Link*
Start with https://. "View Website" button will lead to this page.
Your Areas of Expertise (for high school students)

CollegeSecondary SchoolTherapeuticSummerGapOther
Email Address that Responds to Inquiries*
Completed inquiry forms will be emailed to this address. It is NOT visible on your listing.
Phone Number

Area CodePhone Number
Summary Description

Summary of your services in 500 words or less.0/500
Are you interested in submitting a Guest Blog Post?

YesNoNot sure
Should be Empty:

IECA Member Listings Upgrade Request