We're Hosting Another Family Dinner - Virtually!
Providing families that are directly impacted and harmed by incarceration with a safe space to receive support and resources.
Name
*
First Name
Last Name
Email
*
example@example.com
City or Zip Code
Phone Number
-
Area Code
Phone Number
1. How are you impacted by incarceration?
*
I am formerly incarcerated.
I have a loved one currently incarcerated.
I have a loved one who is formerly incarcerated.
I am not personally impacted, but I am interested in being an ally and supporting those currently and formerly incarcerated, and their families.
2. Last year we focused our dialogue on the History of Mass Incarceration & How it Impacts Our Families, this year we'd like to focus on 1-2 specific aspects of family wellness. But, first we'd like to know if any of the below topics are of concern or interest for our families this year. Are you interested in discussing any of the below topics directly related to mass incarceration?
Re-Entry Navigation and Support
Prison Reforms and Recent Legislation
Staying Connected to Incarcerated Loved Ones
Preparing for Release and Board of Parole Hearings
Covid-19's Impact on Local Jails and CDCR Prisons
The Movement to End Mass Incarceration/Abolish Prisons
None: I'm interested only in Family Health & Wellness specifically.
Other
3. Rate how important these areas of your family's wellness currently are to you and your family.
*
Most Important
Important
Slightly Important
Not Important
Communication and Conflict Resolution/Accountability
Parenting /Co-Parenting
Structure: Scheduling, Organization, Work-Life Balance, etc.
Healing and/or Breaking Generational Cycles
4. Are you, your loved one, or anyone in your family currently concerned about, or in need of assistance with, any of the following?
Emotional Health and/or Stress Management
Family Reunification, Child Custody, or Child Care/Parenting
Financial Security, Housing, Food, Transportation and/or Clothing
Relationship Building, Social Development, and/or Support Networks
Technical Support for Virtual/Distant Learning or Working
Voting and Voter Education
5. What would you hope to learn from a dinner and dialogue about family health and wellness?
*
Parenting/Co-Parenting Help
Time Management/Work-Life Balance
Communication and Conflict Resolution
Resources for Financial Support
Tips/Support for Virtual Learning/Working
How to Get Your or Your Family Involved in Advocacy or Grassroots Organizing
Healing and Addressing Generational Trauma/Cycles
Practical Resume/Job Search Skills
Improving Communication with Incarcerated Loved Ones
Building Supportive Social Connections/Groups
Other
6. We are planning this event for the month of October, and want to make sure our families can attend. Let us know the best dates and times from the below, during which you'd be able to attend a virtual dinner 1-2 hours long. Select All That Apply.
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5:00 pm
6:00 pm
7:00 pm
8:00 pm
Generally Not Available
Tuesday
Wednesday
Friday
Saturday
Sunday
7. We are working to provide free dinner or gift cards for our families who are impacted by incarceration. If you are impacted, please indicate your family size.
Please include adults and children whom will be attending with you, or present in the household while you attend.
8. If you have an incarcerated loved one(s), is it possible for them to call you during the times you selected above?
Yes
No
Other
9. Questions and Comments - Please include any topics of discussion that you'd like us to consider, any immediate assistance or needs that you or your loved one(s) may have, and any suggestions for us to make this a great virtual family dinner and dialogue.
Thank you for your time! We will be following-up with you to confirm:
Event Date and Time
Event Agenda
Dinner Availability
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