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Parents Learning, Understanding and Succeeding (P.L.U.S.) Application
Thank you for your interest in The P.L.U.S Program.
Please complete the information below and I will contact you within 48 business hours to provide the next steps.
I look forward to speaking with you!
To learn more about Chauntology Speaks, visit
chauntologyspeaks.com
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Your first & last name
*
Your answer
Your email address
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Your answer
Your phone number
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Your answer
Preferred method of contact?
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Call Me
Email Me
Text Me
No Preference
Age of your child(ren)
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Birth - 5 years
6 - 12 years
13 - 18
Combination
Why is it important for you to participate in this program?
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Your answer
What goal(s) would you like to have achieved by the end of our time together?
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Your answer
Describe your current parenting challenges.
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Your answer
This is an intensive 7-week program that will require a serious investment of your time and money. Are you ready to make that commitment?
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Yes
No
Which payment method best fits your needs?
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Payment in full
Payment plan
I need to discuss other payment options
How did you hear about this program?
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Your answer
Is there any other information you'd like to be considered when reviewing your application?
Your answer
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