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Community Support Services

Pieces of Peace signup

First Name *
Last Name *
Address Line 1 *
City *
State/Province *
Postal Code *
If Tubman needs to call you, is it safe to leave a message?
Is it safe for Tubman to email you a link to the group meeting?
Do you have a safety plan?
Is it safe for Tubman to email you safety planning information?
I understand that all information shared within this support group is confidential, and I agree to keep that confidentiality for all participants.
Please check box to indicate your agreement.

The following demographics questions are for Tubman's data collection purposes. All answers will remain confidential.

Which race best describes you? (You may select multiple options.)
Do you have any of the following conditions or disabilities (You may choose as many as apply)?

Thank you for signing up for Pieces of Peace. You will receive an email soon with more information about joining the virtual group. 

If you need any assistance, please call Tubman's 24-hour resource and crisis line at 612.825.0000.