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So you’d like to be in a small, mutual support network – also known as a “cell…”

• The purpose of this survey is to give everyone the best possible match in the soon-to-be-formed small groups.
• Please fill out this survey by July 22, 2015.
• We will contact you a couple of weeks later to let you know who is in your group.
• Your responses on this survey are confidential and will not be shared with anyone other than those doing the “matching.”
• If you have any questions, contact bratthive@gmail.com.
• Please also check out our website www.hivemutualsupport.net

* 1. What is your name?

* 2. How often would you like to connect with your group? (Check as many as you want.)

* 3. What are the ways that you’d like to connect? (Check as many as you want.)

* 4. Where would you like to meet with your group?

* 5. We will try to match people up in a way that meets your transportation abilities and needs. Which town do you live in?

* 6. We will try to match people up in a way that meets your transportation abilities and needs. How do you get around? (Check as many as you want.)

* 7. Are there certain issues where you’d feel more comfortable if the other people in your group shared them in common with you? If so, what are they?

* 8. Who would you feel most comfortable being in a small group with? Is there anyone you would not feel comfortable being in a small group with? (You can use people’s names here. If you were not at the "mixer," this might be a hard question to answer. You can leave it blank, if that makes sense.)

* 9. What is/are your preferred contact method(s)? (Please check as many as you want and share that contact information.)

* 10. What days and times are best for you to meet?  Or, what days and times generally do not work at all?

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