Getting to Know You (for Individual Peer Support)

Filling out this form will add you to our waitlist should we reopen, please know this could take a long time and consider getting support elsewhere.

This is a voluntary form you can fill out so we can place you with an individual peer support person. Please only share what you feel comfortable disclosing - this info will be shared with our team to help match you with a peer supporter and your answers will be shared with them before your initial session.

You can always share more details with your support person if you are comfortable once you meet them, again, this is just a voluntary form to help us get to know you and place you with a support person. If you'd rather explore our facilitators on your own, instead of being matched, you can explore our supporters and contact someone directly using this list:

**Please be aware it may take 5-7 days to hear back from us - we also won't be able to respond unfortunately if contact information isn't provided**

If you have any questions or access needs you may email 
Sign in to Google to save your progress. Learn more
We Support What Works For You
We want every person accessing our offerings to know that we support whatever resources feel best, most comfortable for you. That means it is absolutely okay if you don't feel comfortable with a particular support person and want to try connecting with someone else. You have the option of connecting with multiple supporters as well. You may also find that peer support isn't a fit for you in general and that is also okay! We support whatever works for you.

What Peer Support Is:
🌸 Voluntary
🌸 Confidential*
🌸 Consensual.
🌸 Peer supporters engage in a way that centers the consent and boundaries of the person being supported.
🌸 Those being supported respect the ways or topics a peer supporter is comfortable holding support for.
🌸 Autonomous, the person being supported is the driver of their choices. There's no “one size fits all approach”, advice is only given where asked for and from a place of “I”.
🌸 Mutual, the peer supporter and the person being supported are equal; the peer supporter strives to deconstruct any inherent power hierarchies.

What Peer Support Is Not:
🌸 24/7 support, we are only available during planned sessions. Other communication may take time to respond to.
🌸 We are not clinicians, therapists, or case managers. We will not “treat” you, “fix” you, analyze you, or diagnose you.
🌸 This is unique and not a replacement for other services.
🌸 Carceral - we seek to avoid things that may take away somebody’s autonomy.
🌸 A dating service or space for romantic/sexual advances.

*We emphasize confidentiality but in instances of harm towards our supporters, depending on the level of harm, a Peer Supporter may breach confidentiality if it is affecting their physical or emotional safety. (ex: sharing what happened with Peer Support Space leadership).

We encourage communicating what your wants, needs, and boundaries are and want to learn how YOU want to be supported.
DUE TO A LARGE INFLUX OF SUPPORT NEEDS WE CURRENTLY ARE NOT ACCEPTING NEW MEMBERS FOR 1:1 SUPPORTFilling out this form will add you to our waitlist should we reopen, please know this could take a long time and consider getting support elsewhere.
What is your name? (Legal name not required)
What are your pronouns?
Please put your email or phone number. Let us know how you prefer being reach out to (ex: call, text, email, any of the listed ways). *
What brought you to looking for 1:1 peer support?
While we know needs/wants can change, which of the following things interest you (check all that apply)?
Are there any ways you DON'T want to be supported? Please let us know if you have any triggers, boundaries, or things you would like to avoid when receiving support.
Generally speaking, what is your availability?
Is there anything else you would like to share?
What kind of lived experience or identities, if available, would be most helpful in a peer supporter? (Ex: Somebody LGBTQ+, Somebody Spanish-Speaking, Somebody who has experience with depression, etc.)
Peer services are individualized and look different depending on the individuals present - members and supporters. Each peer supporter and member can continually add to their mutual agreement together. Below is Peer Support Space's general Mutual Agreement for 1:1 Peer Support. Do you agree to the below?
Captionless Image
Clear selection
Clear form
Never submit passwords through Google Forms.
This form was created inside of Peer Support Space. Report Abuse