Green Valley-Miri Student Groups Interest Form

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Please note: Completing this form only informs the school of your interest to sign up or refer someone to a group. Official enrollment into the group occurs at a different stage in the recruitment process, which includes a screening and a parent permission slip.

Email *

Your Name: *

Role: *

Teacher/Staff

Parent/Guardian

Student

Student Name and ID #: *

Grade of Student: *

6th

7th

8th

Does this student require para support? *

Yes

Unsure

Does this student have a history of: suicidal thoughts/attempts or self injurious behavior (i.e., cutting) *

Yes

Unsure

Does this student have an individual therapist? *

Yes

Unsure

Does this student have A lunch or B lunch *

A Lunch

B Lunch

Share your concern (1-2 sentences): *

Topic(s) Interested in: *

Let's Have Fun (Skill building that promotes empowerment & underscores limitations of attaching happiness to future events/circumstances)

Healthy Communication/Peer Pressure, What is it? How to Overcome it. Level 1

Healthy Communication/Peer Pressure, What is it? How to Overcome it. Level 2

Black Culture is Misunderstood

Anger Management/Conflict Resolution (Learning healthy ways to manage anger/navigate conflict)

Bullying Peer Mentorship (Learning what bullying is, receiving support to stop it, & anti bullying art campaign)

Anxiety, What is It? And, How to Cope.

Anxiety Level 2 (Only students who have completed level 1 are elegible to join this group)

Anxiety Level 3 (Only students who have completed levels 1 & 2 are elegible to join this group)

Required

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