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APDA Support Group Facilitator Interest

Thank you for your interest in volunteering to be a Parkinson’s support group facilitator. We are looking for mental health professionals and/or health care professionals. Please tell us about yourself and your availability and we will be in touch as needs arise in the community.
1.Name:(Required.)
2.Phone number(Required.)
3.Email address:(Required.)
4.What is your professional background?(Required.)
5.Are you currently:
6.If working, where do you currently work?
7.Tell us why you are interested in facilitating a Parkinson’s support group, please include any connection to PD, if applicable.(Required.)
8.What support group format are you interested in?
9.Are you interested in facilitating a:
10.In general, which timeframes are you available to facilitate a group? (Check all the apply)(Required.)
11.Our chapter serves Missouri, Central Illinois, and Southern Illinois. Which general areas are you interested in facilitating a group? (List counties or general areas of town)(Required.)
12.How soon could you begin volunteering?(Required.)