TRACC Community Care Request Form: COVID-19
This form is specifically for community members in the United States (and beyond) who are struggling (as so many of us are) during this moment and could use a listening ear to check-in with individually or in community groups.

Our Community Care Providers are individuals with background across a variety of healing care disciplines (mental health, holistic wellness, peer support) who are willing to be a listening ear and open to facilitating space of check-in and supportive care for community members around the United States (and beyond) during this stressful time which brings relational, financial, spiritual, and emotional stressors on us as a national and global community. And, we know that organizers, activists, and marginalized community members are faced with a number of intersecting and growing stressors--from the personal, to the systemic, to the global.

TRACC (trauma response and crisis care) for Movements was a project grown out of the stress and unrest within communities of community organizing, activism, and social change - which is also multiplied in marginalized communities. The original intent of this project was to mobilize to support community crisis and stress within and beyond social change. And, we believe that, in many ways this is a time of radical social change and deep community crisis. We hope that the vision for which this project was born can be leveraged to support this kind of care in this moment. For more information on TRACC you can visit us at tracc4movements.com.

If you have additional questions please feel free to email us at tracc4movements@gmail.com. This is not psychotherapy or clinical mental health treatment. This is a network of peer support with community members with experience assisting folks through stress on a voluntary basis. If you are in crisis or are a danger to yourself or others please call 911 for immediate healthcare assistance.

Once your form is completed we will get back to you as soon as possible. We aim for 48-hours response time at latest but this is sometimes contingent on having available support providers to provide check-in for you. We are glad that you are connecting and reaching out and we look forward to being able to support you. It is hard, often, to reach out for support, but in times like these we could all use a listening ear to connect with.

Additionally, you can see the growing resource guide from TRACC4Movements for additional hotline and other resources for specific needs and support here: https://docs.google.com/document/d/1UVF9Yt6H0SZ8-TujNIiVZZ-5aRs9b9RW72FLRFKGRvQ/edit?usp=sharing
Name: *
Your answer
Gender Pronouns (check all that apply) *
Required
Email Contact: *
Your answer
Phone/Messenger Contact: *
Your answer
Issues You Are Struggling With: (check all that apply) *
Required
I am interested in checking with someone.... *
Anything specific you think we should know about what your needs are.... *
Your answer
When are you available to connect with someone? Be specific about days and times throughout the week when you are/aren't available. *
Your answer
For community care circles (groups) and interactive webinars (educational programming) when are you most available? Check all that apply. (approximately - time zones will vary)
Do you have capability to connect via facetime, google chat, zoom and similar mediums? *
Anything else you want us to know at this time? *
Your answer
Do you understand that this is not in place of mental health services, but serves as a peer support check-in with persons with some training and background in providing this kind of support and does not replace immediate crisis care needed from a mental healthcare provider? Please verify yes if you certify you understand the parameters of this offering below and by stating yes that you are willing to participate in this kind of support. If you need immediate care please dial 911 for assistance. *
Your answer
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