Glial Program Sign Up
The Glial Program is a personalized function of Synapse that pairs a Virginia Tech student with someone who has experienced brain injury. We foster friendships between these two communities. Students and individuals who have experienced brain injury meet with each other on a regular, pair-defined basis and attend group events together. It is our intention for individuals with brain injury to spend time with someone who will become a supporter and close friend. The Glial Program sets out to encourage as we grow in perspective and experiences together.

We want to thank you for your interest in the Glial Program! Please fill out our quick questionnaire to help us pair you with an available student so the fun can begin.
Email address *
Name *
Your answer
I am a... *
Required
What's the best way we can contact you in the future? *
If email, please make sure your email is spelled correctly above. If phone, please leave your phone number.
Your answer
What is your address?
Your answer
What transportation is available to you? *
Required
Ideally, how often would you like to meet with your student buddy? *
Required
How would you like to interact with your student buddy, in addition to in-person? *
Select as many (or as little) as you like.
Required
What are you looking for in a student buddy? *
e.g. Someone to go to events around Blacksburg with, to talk to, walk with, get meals with, etc.
Your answer
What are some of your interests and hobbies? *
Your answer
Is there anything related to your health that you want us to know? *
e.g. Is there anything that may make certain activities or events more (or less) difficult for you?
Your answer
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