Ready for Real Life Instruction and Education
Program Registration & Intake Form
2 Pages
First Name
Last Name
Email Address
Phone Number
School / Organization
City & State / Country
Your Role - check one:
K-12 Teacher
University / College Instructor
Faith Community Leader
School Counselor
Community Program Facilitator
Parent / Guardian
School Administrator
Youth Organization Leader
Other Educator / Coach
How did you hear about MMMF?
Colleague / coworker
readyforreal.life
Conference / event
School administrator
Social media
Word of mouth
Other
Implementation Track(s) - check all that apply:
Grades 7-8 (Foundational)
Community Youth (After-school / flexible)
Grades 9-12 (Levels up annually)
Community Adult (Workplace / family)
Preferred Delivery Format - check one:
Daily elective (45-60 min)
Advisory / enrichment block
Online / hybrid
A/B block (90 min)
Community workshop series
Not sure yet
Anticipated Start Date
Estimated Class / Group Size
Have you completed the MMMF Teach the Teacher Training?
Yes - fully certified
Not yet - interested
In progress
Please send training info
Describe your student or participant population:
Most pressing soft-skill gap(s) - check all that apply:
Respectful communication
Accountability & repair
Digital citizenship
Decision-making under pressure
Emotional regulation
All of the above - they need the full program
Current confidence facilitating SEL / life skills content (circle
one):
1
2
3
4
5
1 - Not confident5 - Very confident
What support would help you most before your first session? -
check all that apply:
One-on-one coaching call with Michael
I'm good - just need the materials
Access to digital curriculum portal
Parent / community comms template
Sample lesson plan for my track
Anything else the founders should know before your first
session?
By signing below I confirm:
The information I provided is accurate.
I understand this form initiates my MMMF program
enrollment.
My information will be used solely for MMMF onboarding by the
founders.
Signature
Date
Printed Full Name
Ready for Real Life Instruction and Education | MMMF LLC —
© Michael R. Terry & Mekenzi G. Terry. This intake form
is part of the MMMF program materials and is provided for
authorized program use.