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

What is your name?

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* 1. What is your name?

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

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

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

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

Where would you like to meet with your group?

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

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

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

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.)

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* 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.)

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?

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* 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?

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.)

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* 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.)

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

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

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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* 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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