Online Event Interest Form

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Online Event Interest Form

Are you a new member to our community?

Yes

Clear selection

Full Name

Which topics are you most interested in for future community events?

Relationship & Roles (i.e., Couples and family stressors, Caregiver burnout)

Arts & Culture (Poetry and Art - Restorative Practices)

Health & Wellness (PMS, Menopause, Anxiety, Self-care support)

Career Development (Professional Development/Mentorship opportunities)

Skill Development (Time Management, Organizational skills, habit tracking)

Financial Literacy (Budget and financial constraints and stressors)

Faith-Based Mental Health (Spiritual and Religious)

Other (please specify in comments)

Which programs are you interested in? (Check any or all that apply):

Art & Poetry Wellness Workshops (Individual)

Art & Poetry Wellness Workshops (Organizations)

WE CAN - Women's Empowerment - Community And Network Opportunities (Free Private Group)

FL Residents ONLY - Women's Group Counseling (Chronic/Reoccurring Depression, Anxiety)

Scheduling Preferences

Which days are best for you?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Commitment & Frequency

How often would you like to meet? (Check all that apply)

Weekly

Bi-Weekly

Monthly

One-Time

What time of day works best? (Check all that apply)

Morning (9am–12pm)

Afternoon (12pm–4pm)

Evening (5pm–8pm)

Alternative Language Preferences

Spanish

French

Creole

Portuguese

Hebrew

ASL

Clear selection

Interested in using insurance for applicable groups

Yes

Maybe

Any additional comments or questions?

Consent: I want to be contacted to find out more about group enrollment options:

I agree

I disagree

Clear selection

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