Teen Lifeline CIS Group Confirmation 2016-17
Please fill out this short form to confirm the use of the "Life Lived Better" curriculum at your school.
Name *
Your answer
Email address *
Your answer
School *
Your answer
Cell (for expedited contact during the school year) *
Your answer
Do you need a first group kit? *
School address *
Your answer
Do you anticipate this to be an open or closed group? *
How many students do you anticipate in your group? *
Your answer
When do you anticipate starting group? If you are not certain, estimate to the best of your ability. *
MM
/
DD
/
YYYY
Do you have a group topic? *
(i.e. stress, anger, grief, life skills) If not, just write "general"
Your answer
Which curriculum will you use? *
Do you have any questions or feedback for us?
Your answer
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