PMH Listening Circles Application
Please complete this to apply for a place on the next Listening Circles program
Email *
Do you have a diagnosis of PTSD? *
What is your name? *
Why are you interested in Listening Circles? What do you hope to get from it? *
What is your biggest challenge at the moment? *
Can you commit to 2 hours every fortnight for 4 sessions? *
If you are selected, we'll need you to sign out agreement to ensure the space remains confidential and safe. Do you agree to this? *
Do you have access to Zoom and headphones? *
Do you agree to complete each week's short anonymous survey? *
Is there anyone you would not want to be in a Listening Circle with? *
Next
Never submit passwords through Google Forms.
This form was created inside of Parenting Mental Health. Report Abuse