Group Therapy Proposal

Complete the following form to submit a therapy group idea! This proposal will be sent to your area director to be reviewed. Being thorough and detailed in your responses is incredibly helpful at this point in the process.

Clinician's name(s) that will lead the group:

Group Name

Blurb to describe the group for the website:

You must include a targeted audience for the group here (age, gender, grades, etc).

Which group semester are you hoping to begin group?

Spring 1 - January 22 (4-6 weeks)

Spring 2 - April 1 (4-8 weeks)

Summer

Fall 1 - August 26 (4-6 weeks)

Fall 2 - October 28 (4-8 weeks with Thanksgiving break)

Between Holidays - Thanksgiving to Christmas (4 weeks)

Requested Day of the Week:

Number of Sessions:

Start Date

YYYY

End Date

YYYY

Requested Start Time:

Hour

Minute

Second

Duration of the each session:

(45 min, 50 min, 1 hour, 1.5 hours, etc)

Requested Location:

Conference Room

Group Room

Other

If other, please describe:

Will you have a supply fee? If yes, what will the fee be?

Please keep between $10-25 if possible.

Therapeutic purpose of the group:

Please provide a rationale for why there is a need for this group and how the group will address the need.

What will the style of the group be?

(psychoeducational, process, support, blend etc)

Session Content:

Please list each session and briefly state the session's goal will be and how the goal will be achieved.