Sexual Assault Support Group - UI Campus Location 
This form is to gage interest and required to identify your contact information to be a part of group. 2025 groups are focused on healing processes after sexual assault. Adult survivors ages 18 and up are invited to complete this form to be contacted by a group leader. *If you are under 18 and in need of support, please call our crisis line at 1-800-373-1043 to be connected with an advocate. 
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Email *
PLEASE READ BEFORE COMPLETING SURVEY
Facilitators are Certified Sexual Assault Advocates with DVIP&RVAP, an independent, non-profit organization. 
- We are a confidential group with guidelines for participation
- Transportation is not provided at this time - please let us know if this is an issue in case we can help. 
- Childcare is provided for children 12 and under with advance notice
- You MUST meet with an advocate before attending group - location of group is provided at that time. 
- It is suggested you have an established working relationship with an advocate prior to group
- Advocates are unavailable to meet after group. Please call our 24/7 hotline at 800-373-1043 if needed.  
Do you feel ready to engage about your trauma related to sexual assault in a small safe group? Yes or No is fine. Or feel free to add a bit more.
First and last name - this will not be shared in group - you may share the name you prefer in group.  *
Will you need childcare? (Note: childcare only provided for children 12 and under.) *
If yes, how old are your children?
Do you have access to outside support such as an advocate, counselor or physician for one on one issues?
 *
What are you hopeful support group can help with? 
 *
Can you (basically) commit to a full session? (6-8 meetings)
 *
This form just brought up feelings. Take a breath for yourself. Count to four as you inhale, four as you exhale. Try to hold for four in between those breaths if you can. After this short grounding breathing exercise, how do you feel at this moment. *There are no wrong answers. 
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