PROGRAM APPLICATION

We're excited that you've chosen to learn more about our program and look forward to working with you to develop a customized that will empower your student to shine. Please fill out the form below and we will be in touch with you shortly to discuss next steps.

Student's Name

Contact Number

Student's Age

Guardian's Name

Contact Email

Student’s Current Grade (or most recent grade completed)

Student's School of Attendance

Below is a list of general concerns. Please mark all that apply:

Planning/Organization

Time Management

Initiation

Goal Setting and Follow-through

Task Completion

Self-Evaluation

Attention

Motivation

Self-Advocacy

Social Skills

Emotional Regulation

College Admissions Process

In the box below, please provide a brief overview of your specific concerns:

Which of the following Point and Focus programs are you most interested in hearing about? (check all that apply)

Assessment to determine student’s current intellectual

Executive Skills Training

Life coaching

Peer Groups

College Counseling

Personal and/or Family Counseling

Thanks for applying!
We will be in touch with you shortly.

Head Office

24800 Chrisanta Dr
Ste 120,
Mission Viejo, CA 92691

Phone: 949-951-7050

Fax: 949-454-8650

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Inquiries

For any inquiries, questions or commendations, please call: 949-951-7050

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