HOPE Support Group Interest Form
Thank you for your interest in this group! Please fill out the following information and we will contact you soon.

Hope Support Program Details

Dates & Times:
Currently scheduled for Monday: 5:00 - 6:00 PM (English Session & Spanish Session - Virtual)
Additional groups will be added to fit the interest of families.


Duration: 6 weeks

Cost: Complimentary (no cost)

Participation: Each group will have 5-10 participants. A minimum of five participants is required to begin each session.

Next Step: Intake Process
Before the program begins, we ask all individuals or couples to complete a brief intake session to help us understand your needs and ensure the group is the best fit for you.
We  will be reaching out to complete the in-take process before Session 1.  

We look forward to welcoming you to the HOPE Support Group and supporting you as you navigate this journey.

Sincerely,
Family Support Services Team
Ronald McDonald House Charities- Central Texas
 
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Email *
CONTACT INFORMATION
Parent #1- First and Last Name *
Parent #1- Phone Number *
Parent #1- Email Address *
Parent #2- First and Last Name *Please put N/A if not applicable* *
Parent #2- Phone Number  *Please put N/A if not applicable* *
Parent #2- Email Address  *Please put N/A if not applicable* *
Mailing Address (street, city, state & zip) *
When did the loss of your child or children occur? *
Please provide the cause of death.  *
Have you participated in any previous counseling for this loss? If so when? *
Will your partner or spouse attend the support group as well? *
Do you have any other children? *
If so, what ages are your children?
What would be helpful for us to know about you?
How did you find out about the Support Group?
Prior to starting the Session an in-take session is required with our coordinator. 

Please select your preferred day and time for a coordinator to reach out to you.
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Required
Please provide your preferred type of session. *
Required
A copy of your responses will be emailed to the address you provided.
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