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Expression of Interest to attend Circles of Support programs
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1.
What is your name?
(Required.)
*
2.
Contact phone number
(Required.)
Phone Number
3.
Contact email address (optional)
Email Address
*
4.
Which future Circles of Support programs are you interested to attend? (Tick all that apply)
(Required.)
Darwin
Palmerston
Alice Springs
Katherine
Online program
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5.
Why are you interested in the Circles of Support program? (Tick all that apply)
(Required.)
To meet other people with a loved one who experiences issues related to mental health, alcohol or drug use
To learn about mental health, alcohol and drug related misuse and co-occurring issues
To understand recovery and ways to support recovery
To learn ways to support your own wellbeing and practice self-care
To manage overwhelming emotions and responses
To learn how to identify and respond during a crisis
To learn how to respond to sigma and discrimination
To learn ways to effectively communicate your needs and rights
To learn how to set boundaries
To access support for myself
To understand how to navigate the mental health and alcohol and other drug service system
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6.
Please confirm the following background information: (Tick all that apply)
(Required.)
I am over 18 years of age
I have a loved one who experiences an alcohol or other drug and/or mental health problem
At this point in time, I can commit to attending most/all of the sessions I have indicated
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7.
Please confirm that you are the person named in this Expression of Interest form, or that they have provided you with consent to fill the form in on their behalf:
(Required.)
I agree
