Education Survey

Personalized Mindfulness

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Personalized Mindfulness in Education Needs Assessment

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Organization *

What specific needs in your organization would you like our modules to address? (Select All That Apply) *

Introduction to Personalized Mindfulness Classroom Management Detention Reform School Culture Communication & Trust Issues Public Speaking Stress Reduction Motivation Time Management Mindfulness for Administrators Mindfulness for New Faculty & Staff Creativity Decision-Making and Problem-Solving Test Performance & Anxiety Student Behavior Modification Fun Ways To Teach Kids Mindfulness

Other needs: *

Number of Attendees: *

Please list common sources of stress experienced by attendees (be as specific as possible): *

Preferred Formats (Select All That Apply) *

Onsite Virtual Single Workshop Series Workshops Lunch and Learns Full Days Written Modules and/or Curricula

Other Format: *

If on-site, where is the venue and what audiovisual equipment would be provided? *

Is It A One-Time Event Or Recurring? *

One-Time Event Recurring

When would you like this to take place? *

Month / Day / Year

Support Structures Needed: *

Weekly Follow-Up & Feedback Central Mindfulness Internal Website Professional Evaluation Integration 1 on 1 Mentoring Refresher Programs Lunch / After Work Group Faciliation

Please provide any additional information: *

Submit

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