UMass Amherst YouMass People Finder

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Thank you very much for submitting information about your Support Group!

With your help we can keep providing the western Massachusetts community with up-to-date information about the resources available in our community. If you have any questions, please email us at ewcrr@stuaf.umass.edu. Once we receive your updated information, we will contact you to confirm the information submitted.

This form is also available in pdf format.


GENERAL INFORMATION

Sponsoring Agency:
Agency Phone:
Agency Fax:
Agency Email:
Agency WWW-Site:

Mailing Address: Physical Address:

SUPPORT GROUP INFORMATION

Title of Group:
Description:
Eligibility:
Location:

Date of First Meeting: Date of Last Meeting:
Day of Week: Day of Week:
Time: Time:
Size of Group:

How often do you start new groups?

IS THE SUPPORT GROUP
Free? Yes No
Ongoing/Permanent? Yes No
Drop-In? Yes No
One-Time? Yes No
Open after First Meeting? Yes No
Registration Required? Yes No
Screening Interview Required? Yes No
Wheelchair accessible? Yes No
Child Care? Yes No
Accessible by Public Transportation? Yes No

Fees:
Sliding Scale:
Insurance:
Deferred Payment:
Deadline for Registration:

ADDITIONAL INFORMATION ABOUT THE SUPPORT GROUP


Thank you very much for providing this information.
Please click the button to your support group information.


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