MENASA/SWANASA Support Space Interest Form
Date/Time: Thursdays, 4-5pm
Leaders: Badia Siddiqi, LMFT, LPCC  & Sara Assaad, PsyD
This weekly support space is an offering for MENASA/SWANASA identified students. Providing the opportunity to create community amongst shared identities, offer support, lean into strengths, and explore the intersections of identify and society and the impact it has on students' well-being.

Please complete the following questions, and one of our group facilitators will be in contact with you! 
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Email *
First Name *
Last Name *
Perm Number *
Phone Number
Can we leave a voice message on the phone number provided?
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How do you identify in terms of culture, race, and ethnicity? *
Why would you like to join this group? *
Comments
By checking below, I understand that attendance to this group/workshop is drop-in and I will only receive an initial email reminder. If I have any other questions, I will call CAPS at (805) 893-4411 or email the group co-leaders. *
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A copy of your responses will be emailed to the address you provided.
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