Peer Group Request

Please share the following information so that we can connect you with an available Peer group.

Personal Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Confirm Email

Are you in private practice or do you work with an agency? *

Name of practice, agency, or other practicing arrangement. *

Website of your Practice

Date of your completed Fundamentals of Trauma-Informed Care Course *

Date of your completed SITT Training *

Please indicate your preference for which mode of group you'd prefer. *

I prefer an in-person group if one is near me.
I am willing to participate in a Zoom group if an in-person group is not near me.
I prefer a Zoom group.

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