How Are You Planning to Use the Adjustment Support Curriculum?

REQUEST FOR MATERIALS: Community Adjustment Support Group Curriculum

This curriculum is provided at no cost through a cooperative agreement with Pathways to Wellness and the Office of Refugee Resettlement

Date of Request: Name: Institution: Department (if applicable): Your Position: Address 1: Address 2: City: State: Zip: Country: Email: Phone Number:

How are you planning to use the Adjustment Support Curriculum?

In which populations are you planning to use the Adjustment Support Curriculum?

Are you interested in receiving technical assistance so that your organization can better understand how to use the Adjustment Support Curriculum?

Yes No

May we contact you to better understand how this curriculum has worked or not worked in your community so that we can continue to improve?

Yes No

Thank you for your interest in Pathways to Wellness!

Please return the form to: Pathways to Wellness C/O Beth Farmer LCSNW 4040 S 188th Street, Suite #200, SeaTac WA 98188

You may fax to: 206-838-2680 You may scan to: [email protected]