SIGN UP OR VOLUNTEER!

Please sign up for a user account in order to join our Jewish Commmunity Support Groups network. After you complete this user account information, someone from our team will review it and then will approve your account. You will then receive an email to finish setting up your profile, and can then register for our free, virtual support groups and see all of our other available resources.

If you're a mental health clinician and you would like to apply to become a group facilitator, please also submit this Facilitator Interest Form.

We collect information from you to enhance your experience in our community, and also to ensure the safety and security of our community. Please complete all relevant fields fully! Your responses are private and will not be seen by other participants.

* Required fields are marked with an asterisk

First name *

Last name *

Primary email *

I am a... *

Nickname/Preferred Name

Date of Birth *

Age *

What are you looking to get out of this online community? *

How did you hear about us? *

What school do you attend or are affiliated with (if applicable)? *

Which Jewish organizations are you affiliated with? *

Facilitator Information (REQUIRED ONLY for Group Facilitators)

Can you commit to facilitating weekly sessions?

What mental health degree do you hold?

Are you licensed?

License Type

License Number

Where are you licensed?

What languages could you facilitate a group in?

We require all facilitators to attend a weekly facilitator support/consultation meeting. Are you able to attend one of these?

Participant Information (REQUIRED ONLY for participants)

What types of groups would you be interested in joining?

Personal mobile *

Keep this blank

I give consent for JCMH to use information from this form to create a user profile for me, and to abide by the Group Guidelines and Disclaimer: https://jewish-community-mental-health-initiative.us.hivebrite.com/page/group-guidelines-and-disclaimer *