Faith Transitions Group Screening Form- Fall
This Faith Transitions group is designed to help individuals feel connected, supported, and understood in their personal experiences.  We are eager to foster growth and learning as well as decrease pain and suffering. 

This form is used to help create a safe and therapeutic group environment, to assess group compatibility,  and get additional information that helps facilitators lead groups as ethically as possible. 

After completion, if facilitators feel you are a good fit for the group, we will send out additional links to complete intake paperwork, pay the course fee, and review group therapy agreements. 
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Full Name *
Email *
Phone Number *
Preferred Pronouns *
What is your interest in joining this group? *
What personal goals do you hope this group could help with? *
What do you hope to contribute to the group? *
On a scale of 1-5, how motivated are you to attend all group sessions? *
no motivation
highly motivated
How do you express and handle strong and difficult emotions? *
Where do you find yourself along the "Faith Spectrum?" *
On a scale of 1-5, how much religious trauma have you experienced? *
On a scale of 1-5, how well can you regulate your emotions if the discussion feels triggering? *
Unable to regulate at all and would likely have to leave the room.
Fully capable of regulating and staying engaged with the group.
Is there anything else that you feel would be important for the facilitators to know about you beforehand.  *
Which group are you interested in? (check all that apply) *
Required
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