Family! Focus! Functionality! Program Registration
The Family | Focus | Functionality Program will engage up to 50 Chicagoland families who include students impacted by covid or violence related death via FOUR 1-hour virtual effective communication skill building workshops facilitated by Soul Werk Café.

For eligibility: the household MUST contain at least one HS Senior/College Student impacted by a COVID-19 OR violence related death

If interested in participating, your completion of this registration form will serve as both initial intake and agreement that you will complete all four sessions as outlined in this program.

A member of the Soul Werk Cafe Team will reach out with next steps.

Session costs will be covered by Disruptive INC.

Sign in to Google to save your progress. Learn more
Email *
How have you dealt with adjustments, losses, and changes within the last 2 years? *
Have you shared your experiences with anyone? With any family? *
How often do you initiate conversations in/with your immediate family? *
How confident are you in your ability to have difficult conversations? *
Do you feel confidence in initiating vulnerable conversations in/with family members? *
What subject matters are you hesitant to bring up in conversations with family members? *
Do you know there are several types of communication styles? If yes, do you know your communication style? *
What do you hope gain from this  4 week program? *
Name *
Zip Code *
We are a single parent household *
My family has been impacted by a Covid-19 or violence related death in the last 2-years *
We have a HS Senior or College Student in the home *
Other School Aged Children in the home *
Required
Ethnicity *
My Age Range *
Household Income Range *
How did you hear about this program? *
I understand that this information will be shared with Soul Werk Cafe and additional wraparound service providers. *
Required
I am interested in participating, and will complete all four sessions as outlined in this program. *
Required
Watch Shaniqua Ford, LCSW, members of the Soul Werk team & our Founder chat about self care earlier this year
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms