Student Application Student Application Parents Full Name Email Students Full Name Gender Male Female Date Of Birth Are You Currently In Therapy Or Counseling? Yes No Yes In The Past Seeking Help Now School Type Public School Private School Home School On A Scale Of 1 to 10 How Commited Are You To Completing The 8 Week Course? 1-2 3-4 5-6 7-8 9-10 What challenges are you (is your teen) facing now? What topics are you (is your teen) most excited to explore? What changes to hope to see in yourself (or your teen) as a result of this course? Describe your (teen's) willingness to step out of your comfort zone, share and be open during the course: Submit