Healer Directory for the Anti Police-Terror Project (APTP)
The Anti Police-Terror Project (APTP) Healer Directory is a list of individuals and organizations interested in offering emotional support to families, victims, and other individuals impacted by police terror. Please provide as much information as you can, as these questions will enable APTP to better match healers with community members who are seeking support. If you have any questions about this questionnaire, please email Annie (anniembanks@gmail.com) or Aneesa (anuket@riseup.net). Thank you so much for sharing your skills with people impacted by police terror. You may also reach APTP first responders at:
(510) 394 4659 and https://www.facebook.com/pages/Anti-Police-Terror-Project/513658562107268?fref=ts
As a majority of the people impacted by police terror are people of color, we are seeking people who come from the most impacted demographic as well as sensitive and informed allies. Please describe your racial identity by checking all that apply. *
Required
Please tell us in which language(s) you can you provide services. *
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Please tell us which pronouns you would like us to use when referencing you. *
Are you versed in and competent working with a LGBTQIQA population. *
What age groups are you able to work with? *
Required
Please describe your modality. *
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What do you have experience working with? Please check all that apply. *
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How many sessions can you provide? *
your practice may shape the frequency of sessions, but please describe what you could commit to providing a family member or victim
These next 3 questions are about your ability to provide home visits.
Are you able to do home visits? *
Required
If you are open to providing home visits, what is your zip code? ...
Your answer
... And how many miles are you willing to travel?
Your answer
The next 3 questions are about the space in which you work.
Where is your practice space located? *
Your answer
Are you able to donate space for any of our other healers to perform their services? *
Are there accessibility accommodations for folks who have mobility challenges? *
Required
Please use this space to describe accessibility accommodations.
Your answer
Are you able to offer free or sliding-scale services? *
We feel strongly that the people we serve should not have to pay anything, but in some instances, APTP may be able to raise modest funds for care. If you need to collect a fee, please use the "other box" to describe the lowest fee you can take per session.
In the event that we work with someone who can use insurance to pay for services, which types of insurance can you take?
Your answer
Do you have the ability to supervise a healer that is doing work on our behalf? *
If you can offer supervision, please explain which types of healers you can supervise.
Your answer
Please describe what draws you to the possibility of working with people impacted by police terror. Please also use this space to describe your comfort level in working with issues of psychological trauma.
Your answer
Anything else?
Your answer
Your information.
This information will be used by APTP committee members to reach out to you. We will only share your contact information with potential clients with your consent.
Your Name: *
Your answer
Phone
Your answer
Email address *
Your answer
Website, Twitter, LinkedIn, etc.
Your answer
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