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All form fields are required.

First name

Last name

Date of birth

Gender

Street address

City

State

Zip

Preferred group

Why do you desire to participate in a story group.

Have you done any story work before and if yes, tell us when and in what context?

Please let us know what other groups you have been involved with.

e.g. small group, therapy group, 12 step group etc.

How would you describe your personal experience in the groups you have participated in?

What three words would you use to describe your presence in a group setting?

Have you ever or are you currently involved in professional individual counseling?

How would you describe your current support system?

What do you hope to get out of being in a story group?

Please type your full name, understanding that it is legally equivalent to your signature.

I submit that all the information contained in my application is complete and accurate. I understand that any falsification of information makes my application null.