Peer Support Appointments Sign-Up Form

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The Northern Mosaic Network believes in safe, accessible community support, and we know that sometimes coming to our space can be a barrier, both in and out of a pandemic. There are many reasons why someone would want to book a peer support appointment, including:

-information / support for your sexuality or questioning your identity
-information / support for your gender or questioning your identity
-support for homophobia, biphobia or transphobia you're experiencing
-support for being 2SLGBTQIPA+ in the workplace
-support for coming out, or how to support someone who has come out to you
-support for how to talk to your family about your identity, transition, etc.
-support for families trying to support / validate a 2SLGBTQIPA+ sibling, parent, cousin, etc.
-answering questions about the 2SLGBTQIPA+ community that you feel like you can't ask anyone else
-just to talk or feel connected to community
-more!

Our Peer Support Appointments are for individuals, families, couples or all of the above - no one in our community is excluded. The more information you give us on how to help, the better.

Please note that these are not counselling appointments. Our Peer Support team is made up of staff and volunteers at the Northern Mosaic Network that come from many different identities, backgrounds and professions, with one thing in common: we're here to support you when you need it most.

If you have any questions, please email us at admin@northernmosaic.net.

Email *

Option 1

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Name *

This does not have to be your legal name, and you are not required to give us a last name. We simply use it for booking appointments and to know how to refer to you.

Pronouns *

Age *

Under 12 years old

12-19 years old

19-30 years old

30-45 years old

45-60 years old

60+ years old

Phone Number *

What is your orientation? If you're questioning and/or don't have a specific label, that's okay! *

What is your gender? If you're questioning and/or don't have a specific label, that's okay! *

Are you... *

Two-Spirit

Indigiqueer

None of the above

Other:

Required

Do you want to book with someone who has some of the same identities as you? *

If you select yes, please understand we will do our best to meet your request, and we will let you know if we are unable.

Yes

If you answered yes, what identities would you like us to prioritize when matching you with a team member?

What is the reason for booking with us? Any information you can give will help us prepare for your appointment! *

Please select all of the time frames that you are available for an appointment. *

Lunch Hour (12-1pm)

Afternoon (1-5pm)

Evening (5-8pm)

None

Monday

Tuesday

Wednesday

Thursday

Friday

Our Peer Support team follows a confidentiality agreement that prevents team members from sharing information you share with members outside of the team. The ONLY time we share information to someone outside of our team is if you disclose that you may at risk of hurting yourself, others or know of a minor being hurt. *

I understand.

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