Name *

First Name

Last Name

Phone

(###)

###

####

If yes, when would you prefer to meet via zoom?

Check all that apply

Weekday at 6 a.m.

Weekday at 4 p.m.

Weekday at 8 p.m.

Saturday morning

Sunday afternoon

If you were to meet weekly, what would you prefer from the group?

Check all that apply

Focus on topics (self-care, boundaries, burnout, etc.)

Focus on group discussion

Focus on a mix of topics and discussion

Would you be interested in any of the following?

Check all that apply

Individual Counseling

Training for your school (trauma awareness, boundaries, childhood development, etc.)

Training for your students and/or parents (

Other (please specify below)