<p> REQUEST FOR MATERIALS: Community Adjustment Support Group Curriculum</p><p>This curriculum is provided at no cost through a cooperative agreement with Pathways to Wellness and the Office of Refugee Resettlement</p><p>Date of Request: Name: Institution: Department (if applicable): Your Position: Address 1: Address 2: City: State: Zip: Country: Email: Phone Number: </p><p>How are you planning to use the Adjustment Support Curriculum?</p><p>In which populations are you planning to use the Adjustment Support Curriculum?</p><p>Are you interested in receiving technical assistance so that your organization can better understand how to use the Adjustment Support Curriculum?</p><p>Yes No</p><p>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? </p><p>Yes No</p><p>Thank you for your interest in Pathways to Wellness!</p><p>Please return the form to: Pathways to Wellness C/O Beth Farmer LCSNW 4040 S 188th Street, Suite #200, SeaTac WA 98188</p><p>You may fax to: 206-838-2680 You may scan to: [email protected]</p>