Cultivating Community After College Group Survey
This group is a 6-week group hosted by Wasabi + Well, designed for Black women looking to cultivate new or deeper friendships after college. The purpose of this survey is to get to know you, help you set your intentions, and to acknowledge the purpose of the group. Let's dream together!

* Registration does not guarantee group participation, as we evaluate each registration form to best facilitate group cohesion.
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Email *
Full Name *
Age *
Birthday *
MM
/
DD
/
YYYY
Current Location *
Are you looking to make new friendships? *
Are you hoping to deepen your current friendships? *
How comfortable are you with conflict resolution? *
It makes me uncomfortable
It comes super easily to me
How comfortable are you with setting boundaries? *
It makes me uncomfortable
It comes super easily to me
Has your social life been affecting your mental health? If so, how? *
Have you had a current or past history of suicidal thoughts or hospitalizations? If yes, please explain. If no, please answer "no."
What are you hoping to gain from this group? *
What concerns do you have about being a part of this therapy group, if any? *
Personal Intention Statement: I am committed to doing my best to grow into someone who shows myself and more kindness, compassion, patience, positivity, and love. I believe that I deserve great things and that I have the ability to mold the future that I desire. *
Required
Group Acknowledgment: I acknowledge that there is a confidentiality agreement between myself, the therapist, and everyone else involved in the group. Everything that is discussed within the group sessions will remain within the group sessions. Please fill in your name (first and last) to represent your acknowledgement and signature for the above statement. *
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