HOPE Healing Circle Registration Form 
Healing circles are in person and drop in discussions to focus on topics impacting the Asian American experience and community. This is a safe space to connect with Asian Americans across different generations and meet others dedicated to their healing journeys and mental health and  wellness.

There will be 5 sessions throughout the year. These groups are highly interactive and highly based on discussion. Topics include Asian American identity, family relationships, balancing academics and/or work, resilience, and lived experiences. 
*These groups will be in English with no translation services*

To learn more about the programs, or join a group, please contact Maileen Mamaradlo (she/hers/siya),Asian American Program Coordinator, at mmamaradlo@peersnet.org
Additional information can be found at the campaign website: https://mentalhealthcampaign.org/ and PEERS website: https://www.peersnet.org/
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Name *
Pronouns  *
Email Address *
Mailing Address  *
Which county do you live in? 
What is your age?  *
Required
What healing circle topic are you interested in attending? 

all meetings will be online 
 *
Required
What are some topics you are interested in discussing that are not mentioned in the list above? 
Do you have access to a computer and Wi-Fi? *
What is your specific Asian ethnicity? 
 *
Required
In a 3-5 sentences, can you describe what you hope to learn from the Healing Circle?
*
I acknowledge that I will receive a google calendar invite with time, dates, and location for the Healing Circles: 
 *
I acknowledge that PEERS does NOT offer clinical mental health services or licensed therapy. This  program is facilitated by staff with experience in peers-based mental health services. 

If you wish to seek clinical mental health support or therapy, please refer to the resource guide: https://docs.google.com/document/d/1ga4_U-nhhp6xFTZAzB0sVajpfbc4XC_m_LlLkAMX5tU/edit?usp=sharing
 *
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