Follow-up survey for "T-Group for Women" participants

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We're excited that you'll be a part of our upcoming learning weekend! It will help your facilitators serve you best if you'll provide a bit more information about your background. Knowing what experiences are represented in the room helps us create the best experience possible for everyone.

NAME (First, Last) *

AGE *

FAMILY STATUS (Married/Single/Divorced/Separated/etc) *

# and AGES of CHILDREN (or "none") *

EMPLOYMENT STATUS - Brief DESCRIPTION OF ROLE, and whether you're currently FT, PT, Retired, or Not working outside the home) *

IDENTITY GROUPS

Knowing the demographics and "who is in the room" helps us know more about how to support everyone and whether we will have any "onlies" in our group. *This is for facilitator use and will NOT be disclosed to participants*.

GENDER *

Woman

Other:

RACE/ETHNICITY

RELIGION

SEXUAL ORIENTATION/IDENTITY

NATIONALITY, COUNTRY OF ORIGIN, PRIMARY LANGUAGE

ANY ADDITIONAL DEMOGRAPHIC INFORMATION YOU'D LIKE TO SHARE?

ANY DIETARY RESTRICTIONS for our shared snacks and Saturday evening dinner? Also, we won't be serving any alcohol, but do you have any special beverage needs? *

Anything else you'd like us to know about your participation? Physical needs we should be aware of? Other?

Thank you for your information. We look forward to meeting you soon! Warmly, Jana, Nirit and Tuquynh

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