Caribbean Migrant Women's Emotional Support Group Registration 

1.Please tell us your full name. (Required.)
2.What is your email address?(Required.)
3.Which phone number can the group facilitator contact you on? (Preferably a mobile phone number)(Required.)
4.Do you live or work in the borough of Lewisham?(Required.)
5.What is the first part of your postcode e.g. SE6(Required.)
6.Which of the following genders do you identify with?(Required.)
7.Which age category best applies to you?(Required.)
8.Which ethnicity best applies to you?(Required.)
9.What is your sexual orientation?(Required.)
10.What is your referral route?(Required.)
11.How did you hear about us?(Required.)
12.My emotional and mental wellbeing regularly impacts my life in a negative way.(Required.)
13.I am able to recognise signs and symptoms of poor emotional and mental wellbeing.(Required.)
14.I am able to manage the symptoms of poor emotional poor emotional and mental wellbeing.(Required.)
15.I understand where to access support when I need help with my emotional and mental wellbeing.(Required.)
16.I feel confident talking about my experience as a Caribbean Migrant Woman.(Required.)
17.I understand the impact of being a Caribbean Migrant Woman on my lived experience.(Required.)
18.I experience feelings of shame, guilt or self-blame as a result of my experience as a Caribbean Migrant Woman.(Required.)
19.What are you hoping to achieve from taking part in the Emotional Support Group (please select all that apply)(Required.)
20.In your own words, please tell us what you hope to achieve by joining this Emotional Support Group.(Required.)
21.I would like to receive email updates from Mabadiliko CIC(Required.)
Current Progress,
0 of 21 answered