Confident Life Program™ Request Form - MTA

School & Youth Organization Form

If your school or organization is interested in implementing the Confident Life Program™ in Grades K-3, please fill out the form below!

Identifying needs and key demographics.

Understanding the needs of your school or youth organization is an important first step in selecting the right program to deliver. For instance, schools often recognize the value of social and emotional learning (SEL) for students, though not all will opt to include the Parent program or regular administrator training. Some organizations may choose to start with the training component and later incorporate the student-focused curriculum.

1) Have you evaluated the necessity of the Confident Life Program™ Student Curriculum, Parent Program, or Administrator Training Program?

Yes No

2b) Additionally, please provide the estimated number of children in each grade.

3) Which curriculum duration would best meet the needs of your students?

Full-Year Program: 15 class sessions (one session per week over 5 weeks in the fall, 5 weeks in the winter, and 5 weeks in the spring) Accelerated Program: 9 class sessions (one session per week for 9 consecutive weeks)

4) What type of organization will be responsible for delivering the Confident Life Program™?

Public Elementary School Private Elementary School Homeschool Group Youth Organization (Ex: Boys and Girls Club, YMCA, Community Center, Scouts) Youth Mental Health Agency Pediatrician or Doctor’s Office Other

5) In which languages do you provide services for students and parents?

7) How did you hear about the Confident Life Program™?

8) Have you engaged with the organization's administrative management to discuss the Confident Life Program™ goals, research, and delivery methods to evaluate their motivation and support for its implementation?

Yes No

9) If the administration decides to implement this program within your organization, what would their expected start date be?

10) If the administration showed a lack of enthusiasm, what barriers or challenges were identified? In the event the program is adopted, how will these obstacles be addressed?

11) Who will deliver the Confident Life Program™ to students?

Regardless of an administrator's educational background, the most effective group leaders tend to be those who are adaptable and thrive in a collaborative teaching environment. Additionally, a strong understanding of early childhood development and cognitive social learning therapy proves highly beneficial.

12) Have particular individuals been identified to undergo training for implementing the Confident Life Program™ at your school or youth organization?

Yes No

13) The Confident Life Program™ complements existing SEL initiatives effectively. What other programs are your students currently participating in or have recently completed?

Evaluating the organization's funding and ability to implement the Confident Life Program™.

The majority of the CLP program delivery costs will be incurred during the first year, covering initial training, ongoing supervision, technical support, and the purchase of necessary materials, including limited licensing for the Full Curriculum, Posters, Educational Films, and Books. In subsequent years, costs will decrease due to reduced licensing fees, with optional add-ons available for items such as additional educational books, classroom posters, hand puppets, and more.

14) How much is your organization currently allocating for SEL, mental health services, or other Tier 1-3 prevention initiatives?

15) Will your organization require additional funding to implement the Confident Life Program™?

Yes No

16) Are you considering submitting a grant application? Please note that we do not provide grants or assistance with the application process. We recommend exploring available resources independently to support your effort.

Yes No

Each session includes protocol checklists that outline the content to be covered, the distribution of Parent's Guides, key role-plays, activities, and the issuance of a Certificate of Completion for students. Administrators are asked to complete both a Readiness Survey and a Final Survey, which play a crucial role in monitoring and ensuring the program's delivery integrity.

Which individuals within the organization will be responsible for reviewing program fidelity, ensuring surveys are completed on time, and managing the processing of checklists during program delivery?

Main Contact Name

Phone

School or Organization Name

School Address

Comments and Questions

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CLP Request Form: Schools & Organizations

School & Youth Organization Form

Identifying needs and key demographics.

Evaluating the organization's funding and ability to implement the Confident Life Program™.

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