First Name *

Last Name *

Company

Does your organization currently offer social skills programming? * Yes No Previously, but not currently

What ages/settings would you be interested in offering the Charisma-Virtual Social Training? * Private Practice - Ages 8-18Private Practice - Ages 18+Non-Profit - Youth - Community OrgNon-Profit - Young Adult - VocationalSchool - ResidentialSchool - District/PrivateRehabilitation CenterUniversity Setting

Email *

Phone Number *

Please include a brief Statement of Interest. What experience do you have supporting social skills in youth and/or young adults? Describe your comfort level and/or prior experience using technology as a teaching or training tool. *

To verify your computer tech specs with the Windows 10 Settings app, use these steps: Open Settings, Click on System, Click on About, Copy and Paste Specs in the box below *

Please let us know the likelihood that you will have access to a Windows 10 (or greater) device to provide Charisma Coaching. * 1 - Not Possible 2 - Potentially, but difficult 3 - Likely 4 - Definitely

How did you hear about us? *

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