Please allow 10-15 minutes to fill out this application form, upon acceptance you will be contacted for payment.
What Pronouns do You Prefer?
Street Address Line 2
State / Province
Postal / Zip Code
In a few sentences, can you please share about the circumstances of the death and what happened? i.e. who died and the cause of death
Are you able to share the story in a group?
What has been the hardest thing (what are you struggling with now) re. your grief?
Has there been anything that has been particularly helpful since your loss?
Are there any other stressors in your life right now besides the loss?
What kind of support resources do you have available to you? (friends, family, church, temple, community, groups)
What do you hope to get out of the group/what are you hoping for by participating?
Should be Empty: