Topic of proposed group:
Type of group (select one):
Peer Interest Group
Mentored Interest Group
Special Event Group
Description of proposed group:
Number of group members: Minimum: Maximum:
Frequency of meetings you envision for this group (ie. Weekly, monthly):
If this is a Peer type group, are you willing to be the facilitator?
If this is a Mentored group, are you volunteering to be the facilitator/mentor?
Your email address: