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Holistic Healing Circle
Thank you for your interest in Heal US, Heal DC! My name is Amelia French, Director of Advocacy with Advocates for Justice and Education, Inc. We are hosting healing circles beginning later this Spring. Please take a brief moment to fill out this survey and we will contact you with further detail. For more information, contact me at Amelia.French@aje-dc.org
What is your name & email address?
Name
Email Address
Phone Number
Please enter a valid phone number.
Ward #
Please Select
1
2
3
4
5
6
7
8
Are you a parent or caregiver?
Parent
Caregiver
How many children do you have?
Please Select
1
2
3
4
5
+5
What school(s) do your children attend?
Please give us a brief description of your schedule constraints.
Please select topics that you would like to discuss or need support with.
Stress & Anxiety
Trauma & Resilience
Grief
Physical Pain and/or Addiction
Race & Gender related Issues
Resource Inequity
All of The Above
Not Sure
Submit
Should be Empty: