Life Skills Coaching Intake Form

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This prescreening questionnaire will be used to explore which dimensions of wellness you prefer to work on and allows you to identify your desired area(s) of focus for coaching.

After the initial screening, the life skills coach will work with you to help you set and achieve your goals, working to build the holistic development of academic and personal skills that support your educational and professional journey and well-being. The coaching sessions are informal, skills-based, and practical.

Life Skills coaching is part of a range of multidisciplinary services and resources offered to support our student’s during the course of their time here. We want to help energize you to become experts in your own well-being and success!

Email *

Name (First, Last) *

What is your major?

What is your class year?

Where do you live?

On-campus Residence Hall

Greek Life Housing

Off-campus Commuter

Off-campus Living at Home

Other:

Clear selection

Please select which areas you feel you would like the most support in: *

Well-being

General Life Skills

Educational Transitions

Mentorship

Campus Resource Education

Time Management

Organization

Academic

Professional

Other:

Required

What is one short-term goal for this semester?

What is one long-term goal for your time here at URI?

What factors motivate you the most?

Interest

Personal Experiences

Collaboration

General Health and Wellbeing

Peers

Learning Environment

Rewards

Parent/Family/Caregiver Involvement

Feedback

Being Challenged

Opportunity for Growth

Perception of Others Expectations

Career Outcomes

Achieving Goals

Other:

What factors do you feel make it hard to reach or achieve your goals? *

Lack of Motivation

Lack of Support

Mental Health Struggles

Financial Challenges

Learning Barriers (classroom/dorm)

Insecurity related to food/housing/transportation.

Roommate(s) Conflict

Lack of Peer Connection

Time Management

Inadequate Resources

Employment Status

Family/Home Circumstances

Poor Sleep Quality

Other:

Required

What has been your biggest success so far, and what did you do to accomplish (or are accomplishing) it?

What has been one of your biggest challenges so far, and how did you working to manage it?

What methods help you learn most effectively?

What are some things you have already done to move towards your goal(s)?

What (or who) do you value most in your life right now?

Have you or a family member ever served in the U.S. military?

Yes

Clear selection

How can the Life Skills Coach best support you throughout your time here?

Do you have any questions at this time about Life Skills Coaching?

On a scale of 1 - 10 what is your current level of everyday stress?

No Stress

Higher Levels of Stress

Clear selection

How frequently would you like to meet to review your progress to stay on track with your identified goals? *

One time per week

Bi-weekly (once every two weeks)

One time per month

Other

What is your preferred method to meet? *

Face-to-face Sessions

Virtual Sessions

Mixed (both virtual and face-to-face)

A copy of your responses will be emailed to the address you provided.

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