School Based Grief Support Group Interest Form
Thank you for your interest in grief support for your school community.  Please take a moment to complete this form.  Our Program DIrector will reach out to you within 3-5 business days via the contact information you provide below.

Rick's Place offers peer based grief support programming for elementary, middle, and high school students who have experiened the DEATH of a significant person (parent, sibling, or friend).  They must be between the ages of 5 and 18. Our group sessions run for 6 weeks and are facilitated by a Rick's Place trained facilitator. 

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Email *
School Name
 *
Your Name & Position
 *
Phone Number *
Email Address *
Do you have a need for a school based grief support over the next 1-3 months?
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To the best of your knowledge re: deaths in your school community, please share an approximate number of children you think will attend this group.
 *
Age range of potential participants? *
Our school will ensure a private space for groups to meet during the school day.  *
Our school will ensure a school counselor will be available before or after each group for consultation with our group facilitator(s).  
 *
Our school counselor would like to participate/be present DURING the grief group sessions. *
Please share any additional information you think will be helpful for us to know.
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