Parenting Group Interest Form

You must be currently registered for courses during the Spring 2023 semester to qualify for services.

Parenting is difficult and it can often feel overwhelming when we don't know what to do or what our children need. This parenting group uses The Circle of Security Parenting curriculum and is designed to help parents understand their child's emotional needs. This group will cover ways of supporting your child's ability to successfully manage emotions, enhance the development of your child's self-esteem and honor your inner desire for your child to be secure in their attachment.

This group will meet weekly this semester for 8 weeks on Thursday's from 10-11:30 AM beginning on March 2, 2023, ending on April 27, 2023. There will be no meeting the week of Spring Break.

This group will be made up of 6-8 parenting college students in total.

This group is intended to provide parenting education and an opportunity for therapeutic processing in a group setting led by a licensed therapist. Group guidelines and expectations will be shared at the first group meeting. By attending this group, you will be consenting to group therapy services through the MCC Student Counseling Center.

If you are interested in participating in this group, please provide the following information.

Name

First NameLast Name

Date

Student ID:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Brith

Date

Age

I am a Student at:

Dual Credit (High School)MCCTarleton State UniversityTexas Tech

Telephone

Please enter a valid phone number.

Telephone

HomeCell

May we leave a message?

YesNo

May we send text messages?

YesNo

Email

May we contact you by email?

YesNo

How would you like to be reminded of the appointments?

TextPhone callEmail

To best prepare for the group, please provide the age of your child/ren:

How likely are you to attend this counseling group for 8 sessions weekly this semester?

I can commit to being there every weekI am interested but need more informationI am nervous about opening up in a group settingI am interested, but the day and time does not work with my schedule right now

Are there other group counseling topics you would like to see offered? Please list those here:

How did you hear about this counseling group?