Sign-up for Mile High United Way BTG Racial Healing Practices for Strengthening Family Coping Resources Group

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This group will meet weekly on Thursdays from 4-6 pm at the Mile High United Way offices in March (3/2; 3/9; 3/16; and 3/23). Exact room location TBD. A stipend will be provided for attending the sessions via electronic gift card.

Email *

First Name:

Last Name:

Phone Number:

Email Address:

Are you a caregiver of a child/children aged 0-6?

Yes

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Are you an educator of young children aged 0-6?

Yes

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What Colorado county are you in?

Will you need child care?

Please list the name(s) and age(s) of the child/children you will need child care for:

Please list any food restrictions you have:

Please mark which United Way services you use

Housing

Basic Needs

Early Care & Development

Education & Literacy

Small Business Support

Tax Assistance

Workforce Development

Wellness Coaching & Life Skills

College & Career Readiness

Other:

Please mark which Racial Healing SFCR topics you are interested in

Sharing Our Untold Stories

Reclaiming our Racial Identity

Rest: A Necessary Healing Practice

Identifying Racial Trauma within our Family History

Grieving Racial Trauma

Moving Toward Wholeness

Embracing Chosen Family

Building Connection to Heal from Microagressions

Self-Gratitude: A Racial Healing Practice

Fostering Hope for Extraordinary

Realizing our Dreams

Embracing Creativity

What are your goals or expectations for the Racial Healing SFCR groups?

Have you engaged in any other Racial Healing Practices or Groups?

Yes

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Are you aware most Racial Healing SFCR groups take place in the evening?

Yes

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Do you anticipate any issues with the time of the Racial Healing SFCR groups?

Yes

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Please specify any issues you may have with the time of the Racial Healing SFCR groups:

Do you anticipate any issues traveling to/from the Racial Healing SFCR groups?

Yes

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Please specify any issues you may have with traveling to/from the Racial Healing SFCR groups:

Please share how you learned about the Racial Healing SFCR groups

Referred by Case Manager

Referred by Bridging the Gap staff

Referred by Jin Baek

Other:

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Are you interested in becoming a future Racial Healing SFCR Facilitator?

Yes

Maybe

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What is your Race?

Hispanic or Latino

American Indian or Alaskan Native

Asian/Asian American

Native Hawaiian or Other Pacifica Islander

Black or African American

White

North African or Middle Eastern

Two or more races

Other:

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What is your Gender?

Female

Male

Non-Binary

Other:

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What is your Age Range?

What is your current level of Education

Did not finish High School

High School Diploma or GED

Some College

Associate Degree

Bachelor Degree

Other:

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Please mark Yes or No to the following prompts

Yes

N/A

Do you have a disability?

Are you a Refugee?

Are you an Immigrant?

Are you a Veteran?

Do you have any children?

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