Contact Us – Coaching
Welcome,
Please complete this form to request services or ask questions about academic coaching.
Before completing the form, please review information about the coaching process, including pricing and the initial coaching package (6 sessions and 2 parent meetings) :
https://www.sos4students.com/services/coaching
.
After submitting the form, we'll ask you to schedule a 15-minute time slot for a call with our intake coordinator.
It is not necessary for the students 17 and under to be part of this call. For students 18 and over, we would like students to conduct the calls themselves though they may have a parent present on the call as well.
We currently have open coaching sessions in Walnut Creek and Oakland, please have your student's schedule available to learn about potential coaching options.
By submitting this form you agree that SOS4Students may contact you via SMS for scheduling, reminders, and updates to any programs you have contacted us about or signed up for. For more information please email i
[email protected]
.
Regards,
Beth Samuelson
Director, SOS4Students
Parent
First Names (Parent 1 & Parent 2)
Last Name (Parent 1 & Parent 2 unless same)
Email (Parent 1)
Email (Parent 2)
Mobile Phone (Parent 1)
Interested In
1:1 Coaching
Advocacy
Consultation
Workshops
Custom Workshops
Study Space Makeover
Speaking Engagements
Address
City
Address Line 2
State
Other Parent Information
Zip
Student
First Name
Last Name
School
Grade (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, College)
Preferred Pronouns
I Need Help With (for parent)
504 Plan
IEP
Parenting tips for Homework
Help on school placement
Help on communication
Collaboration with clinician
Challenging Areas (check all applicable)
Task initiation
Attention (In class and/or at home)
Planning (may include planner use and/or prioritizing work)
Managing routines like medications or getting out of bed and out the door
Materials organization
Missing/make up work
Note taking
Procrastination
Test preparation
Self-advocacy
Time management (including morning and afternoon routines and tracking work)
Working more independently
Writing/organization for essays
Emotional regulation
Keeping healthy habits
Adaptability to new environment
Effective decision-making
Self-discipline
Prioritization
Reading and listening comprehension
Attending lectures (for college students)
Student Buy In (to coaching)
Select
Yes - Asked for help
Yes - I initiated
No - Reluctant or will push back
Unknown - Doesn't know I've contacted SOS
Homework Load per Day
Weekly Coaching Availability (if applicable)
Walnut Creek
Oakland
Online
Extracurricular Activities
School Accommodations? (ie IEP, 504, learning planning)
Yes
Evaluations? (e.g. School Testing, Neuropsychological Reports)
Yes
External Services (Content Tutor, Counselor etc.)
Areas of Concern
Referred By
Remove
Add Fields for Additional Student
Submit