Name *

First Name

Last Name

Indicate what format/topics would interest you *

Check all that apply

A curriculum- specific topics each week, structured

Topic focused, but more open to talk with each other about it

What activities interest you?

Check all that apply

Videos that spark discussion/teach

Facilitator presents/teaches topic to discuss

Exercises to do in group that can then be discussed

Meditative/relaxation exercises/techniques

Discussion among members to receive validation

Homework to complete outside of group, then discuss in group

Not sure

What executive functioning areas are the most stressful to you?

Check your top 3

Time management

Emotion regulation

Task initiation/Self-activation

Medication issues

Forgetfulness/memory issues

Impulse control/Self-control