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Peer Support Group Registration
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* Indicates required question
Name
*
Your answer
Email
*
Your answer
Phone number
*
Your answer
Suburb or postcode
*
Your answer
What is your preferred communication method?
Email
Phone
Other:
Clear selection
What do you want from a peer support group? (Tick all that apply)
*
Social connection/activities
Talking about shared experiences
Learning self advocacy skills
Working together to make change in my local community, or more broadly (group advocacy)
Learning different skills
Other:
Required
What is your preferred delivery format?
*
Zoom
In person
Either
What access or communication requirements/preferences do you have?
*
Your answer
Do you have any dietary requirements?
Your answer
What cultural requirements do you have? (E.g. language, religious, etc.)
Your answer
What is your availability? (Tick all that apply)
9am–12pm
12pm–3pm
3pm–6pm
6pm–9pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
9am–12pm
12pm–3pm
3pm–6pm
6pm–9pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
If other, please provide availability below.
Your answer
What is your living arrangement? (E.g. group home, with family, private rental, SDA funded apartment, homeless, etc.)
Your answer
How did you find out about this group?
Your answer
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