Request edit access
Free Monthly Wellness Group for Black Mainers
Groups will be offered by Cross Cultural Community Services and/or led by local experts in each field. We hope that many of those professionals will be people of color, so if you’re familiar with folks you think could lead these discussions, please let us know. Feel free to share this with anyone that you think would be interested. Thank you for filling out this confidential survey.
Sign in to Google to save your progress. Learn more
Email *
I identify as a black American
*
I’m familiar with the Black History Month Community Wellness Fair *
I attended the 2024 Black History Month Community Wellness Fair
*
Please check the box next to each topic that you’re interested in for a free monthly black Mainer’s wellness group
*
Required
CCCS also has initiatives regarding these topics, please check the box next to each topic that you’re interested in:
*
Required
I am 18 or over
*
I would like this group to be held:
*
Please provide the monthly day and time that would work best for you to attend these groups
*
Please share any other important information that you would like to tell us about
*
Would you like to receive our newsletter?
*
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Cross Cultural Community Services.

Does this form look suspicious? Report