#LifeGoals Lab Registration

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* 1. Your Info:

Full Name

Nickname

Email Address

Phone Number (text only)

Name of School

State

Current Grade

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* 2. Have you ever participated in an Inspiring Minds program?

Not Sure

Yes! (Please share the programs/events you've participated in the space below):

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* 3. What are you interested in exploring in the #LifeGoals Lab? (check as many as you want!)

Goal Setting

Adjusting to Change

Time Management

Grief/Sadness/Depression

Worry/Anxiety

How to get/stay Motivated

Friendships/ Social Life

Family

Academics/ School Work

Ways to stay calm and focused

Physical Health

Creativity/ Art/ Special Hobbies

Planning for the future

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* 4. What technology do you have access to? (check all that apply)

I can get online/ i have internet access

I can video chat (via Zoom)

I have a phone

I can print stuff if I need to

I have email

I don't have any of these.

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* 5. Be honest- Can you commit to meeting with your#Lifegoals Lab via Zoom for 30 minutes a week, for 6 weeks?

Yes! I'll be there!

Yes... but I might need reminders.

No... that's too much for me right now.

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* 6. The #LifeGoals Labs meets on Tuesday afternoons. There are two sections- one at 3pm and one at 4pm. Can you participate at one of these times?

Yes, both times work for me!

I CANNOT participate at 3pm

I CANNOT participate at 4pm

If we open another section, what time would work BEST for you?

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* 7. How do you identify? (Choose All that Apply)

Male

Female

Non-binary

Cis-Gender

Gender Fluid

Transgender

Not Sure/ Don't Know

None of these

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* 8. If you join us, we will need to contact your parent or guardian to let them know about your participation in the #Lifegoals Lab.

Parent/Legal Guardian Full Name

Phone Number