MST Reclaimed Retreat Pre-Application

MST Reclaimed Retreat

Date: September 20-25, 2020 | Location: American Legion Wilwin Lodge, Custer, MI
PRE-APPLICATION FORM
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Please answer the following questions:
Have you been diagnosed with, or do you believe you suffer from PTSD?

YES NO Not sure
Have you ever experienced Military Sexual Trauma (MST) or sexual harassment while serving?

YES NO Not sure
Are you currently receiving counseling from a VA service provider or other?

YES NO Other
Are you ready for group therapy?

YES NO
Please explain why you feel you are ready: Type your answer here.
Are you able to attend a 5-day retreat (September 20-25, 2020) at the American Legion Wilwin Lodge in Custer, MI?

YES NO
NOTE: This form reserves your space pending approval during the application process to participate in the MST Reclaimed Retreat. Typically there is a waiting list to attend. Completing this form acknowledges your interest. If you have any questions please contact our MST Outreach Coordinator, Henrietta Hadley at henrietta@wincforall.com
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MST Reclaimed Retreat