1. School Information

School Name: *

Location (City, Country): *

Number of Students Enrolled: *

Age Groups Served (e.g., primary - sixth form / college): *

Could you share insights into the diversity of your student body, including factors such as age, gender, and cultural or socioeconomic backgrounds? *

Are there specific groups of students at your school who would benefit from the 9D Breathwork program (e.g., students with anxiety, EBSA students, those lacking stable home support)? *

2. Contact Information

Full Name of School Administrator Completing the Application: *

Position/Role (e.g., Headmaster, Superintendent): *

Email *

Phone *

Who will be the dedicated staff members leading the 9D Breathwork program at your school? *

What is their experience with mindfulness, mental health support, or similar programs? *

3. Current Mental Health/Well-being Initiatives

Does your school currently offer any programs or initiatives focused on student mental health and well-being? If yes, please briefly describe them (max 2-3 sentences). *

How does your school plan to recruit students for the program? *

Has your school participated in similar programs before? If so, what were the outcomes? *

What challenges do you foresee in implementing this program at your school? *

4. Interest in 9D Breathwork Program

Why is your school interested in participating in the 9D Breathwork program? (Select one or more) *

To improve students’ mental health and emotional well-being

To enhance students’ academic performance through better focus and stress management

To provide innovative tools for teachers to support students’ emotional regulation

Other

5. Capacity and Commitment

Are you able to commit to integrating this program for at least one school term? *

Yes

Are you familiar with the RCADS assessment tool? *

Yes

Do you agree to the use of the RCADS method? *

Yes

Would your staff be available for training prior to starting the program? *

Yes

Does your school have a designated space for the 9D Breathwork sessions? If yes, please describe it. *

What equipment can your school provide for the program (e.g., yoga mats, blankets, eye masks)? *

Does your school have a budget allocation for the program. Please elaborate. *

6. Measuring Success

How would you measure the success of the 9D Breathwork program in your school? (Select one or more) *

8. Feedback or Comments