De-stressify School Strategy Session with Nicole de Picciotto
Thank you for requesting a complimentary Strategy Session.  It's my pleasure to meet with families who are considering academic life coaching as a next step.  Because my time is limited and coaching is only successful if the student is a willing participant, I will only consider applications that have been filled out by the student. However, the parent may ALSO fill out this survey, so that I have access to both parties' perspectives.

All information is completely private and confidential. I'll be in touch soon to let you know about next steps!
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To the student: Please tell me a little more about yourself:
Who is filling out this form?
Clear selection
What is your city, state and time zone?
What school do you attend?
What is your grade level/year in school?
How did you find out about me?
How do you feel about coaching?
Clear selection
student's full name
student's email
student's phone
parent(s) names
parent(s) phone numbers
parent(s) email
What are your interests, hobbies, strengths, etc... Be as specific as possible!
What is your single biggest challenge with school?
What challenges outside of school contribute to difficulties at school?
What specific issues would you like to address through academic coaching? Check all that apply.
Tell me about the grades you are earning and how you feel about them.
What is motivating you NOW to take action to make a change?
Have you been tested for learning differences?  What were the results?
What else would you like me to know before we schedule a meeting?
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