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REACH Club Interest Assessment Form
Interested in learning how to start a similar club at your school? Please read the information below and answer the questions so that we can provide you with the information you need!
Email address *
Phone Number (if you wish to share)
Your answer
Preferred form of contact
Engaging Students to Connect, Learn, & Take Positive Actions
A key aspect of and purpose for offering this series is to share our process, specifically about how we initiated REACH Club, and what we feel are the core elements and its purpose, role, and value within a school culture. Additional topics and resources will be more clearly defined after initiators and participants complete our survey, “Needs Assessment and Conversation Starter.” With new or further understandings on topics such as building and maintaining healthy relationships, stress and anxiety, mindfulness, managing social media, and nurturing well-being (as well as other topics that can support students at their developmental stage), participants will be able to determine, what ways of engaging will work best for (or best fit) their school culture and community needs.

Ana & Kerri
mindfulslo@gmail.com
www.connectbewell.org

Rationale: WHY our approach?
The framework for this series of conversations is designed to initiate much-needed conversations about shaping and supporting teens’ social, emotional and mental well-being.

We see ourselves as change makers. Our purpose is to share our process of initiating a student club to help teens navigate life and respond to stresses. Our goal is to help teens learn skills and acquire tools that they can later apply to other situations they encounter. Our intention is to provide participants with strategies for implementing mindfulness-based practices into their daily lives. We realize that the topics or issues that teens face change over time, therefore there are many aspects that will be tailored to groups’ individual needs. However, we all need to learn life skills and strategies for navigating life and to help us develop into the people we have the potential to become.

Name
Your answer
Town, City or State Where You Reside
Your answer
Brief Description of your school's context to know more about why you want/need such a club (anything you choose to share would be helpful)
Your answer
District or Organization you're a part of or associated with
Your answer
Role or Title
Your answer
Topics of Interest
Your answer
Areas of Concern
Your answer
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