Shero Peer Support Groups Request Form

Exclusive to female Veterans of any era or branch of service.
• Psychiatrically and medically stable for group participation.
• Not currently abusing drugs or alcohol

Please complete this form if you are interested in attending a Shero Peer Support Group.

Group is designed to be small. Limited attendees per session

Peer Support Groups do not replace the need for formal therapy and mental health treatment.

If this is a referral.. please provide your name and contact information.

To get access to exclusive events and assistance you must agree to become a CFVF United (FREE)Member and subscribe to the newsletter*

I agree to the free membership and receiving newsletters.

Groups are offered throughout the year. We will contact you with the exact dates and times of each session after we receive your request.

I am interested in the*

Survivors Peer Support Group SessionsWalk & Talk Group Sessions (Greensboro, NC Only)Coffee & Talk Peer Support Group SessionsSelf-Care Peer Support Group Sessions

Female Veteran Name*

First NameLast Name

Veteran or Contact Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What county do you reside in?*

Phone Number*

Area CodePhone Number

Please provide proof of your military service*

Browse Files

DD214 or VA ID please cover any sensitive information

Valid ID*

Browse Files

We must ensure the person attending the virtual group is the servicemember.

Are you a survivor of military sexual trauma?*

YesNo

Birthday*

Are you currently abusing drugs or alcohol? *

YesNo

Please read:

We have upgraded our technology to an improved ongoing secure engagement platform (Quenza) for all our peer support groups. Please accept the required invitation to be included in our HIPAA- and GDPR compliant software (Quenza) and receive all the free benefits of being part of CFVF United sister-veteran tribe. This platform and mobile app are free for you paid by us. It can only be used by those that we have invited and accepts the invitation. This also eliminates the redundant form and repeat consents for each group. After you accept you will receive an email with the new group information and date/ time questions.

FYI: The invitation will come from email address shero.groups@cfvfunited.com and the subject line states Your organization Care Coordinator CFVF United would like to connect with you.

I have read the above requirement and understand to participate in group I must accept the secure engagement software Quenza.*

Your signature

Please confirm above email*