Participant Interest Form: 2022 Support Groups

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Thank you for your interest! Please complete to schedule your pre-screening phone call.

Email *

First and Last Name *

Would you like to be added to our mailing list for information about future groups and community offerings? *

Yes, thank you!

No, not right now

I am interested in joining the following group: *

If that group is unavailable to me, my second choice is: *

Please select the option that best describes your situation. *

I plan to join the virtual Zoom group on a computer with a working microphone and video camera

I plan to join the virtual Zoom group on a computer with a working microphone but no video camera

I plan to join the virtual Zoom group on a computer with a working video camera but no microphone

I plan to join the virtual Zoom group on a mobile phone with a working microphone and video camera

I plan to join the virtual Zoom group on a mobile phone with a working microphone but no video camera

I plan to join the virtual Zoom group on a mobile phone with a working video camera but no microphone

Potential participants will be contacted by the group's facilitator for a phone call. Please share at least 3 dates and times over the next 2 weeks when you might be available. Facilitators will confirm via text or email before calling you. *

One of our staff will reach out to you during one of the times you indicated; first with a text message identifying ourselves as agency staff and then we will call. If you do not answer or respond via phone, we will email you notifying you of our attempt to contact you by phone. Please share your phone number with area code below. *

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