Section 1: Contact Information

First Name *

Last Name *

Date of Birth (MM/DD/YYYY) *

Email *

Would you like us to sign you up to MDFs newsletter to receive updates regarding MDF events and updates for the MDF community?

Phone *

What is your preferred contact method? *

Street *

City *

State/Province *

Zip or Postal Code *

Country *

How did you find out about the SGF opportunity? * 

Please share more details here: 

Section 2: Personal Profile

Please tell us about your connection to the DM community: * 

Please describe your journey and experience with DM (when you/a loved one were diagnosed, etc.) * 

Tell us what inspired you to apply for the SGF role? Why are you a good fit for this role? * 

What SGF role are you interested in (Men’s Only Group, Women’s Only Group, Mountain West, CDM Caregiver, Co-Facilitator, Other) * 

Please share more details here: 

Please tell us about any qualities, skills, and experiences that you believe will assist you to work effectively as an SGF: * 

From whom/where do you currently receive your support (friends, family, spouse, other)? * 

What are you most looking forward to in being an SGF? * 

What do you think the biggest challenges might be in becoming an SGF? * 

Tell us about specific ideas you have for leading a support group session (e.g., types of topics that you might focus on, etc.). * 

Section 3: Availability & Communication

SGFs are important members of the MDF team and the greater DM community. SGFs often are a friendly face that community members turn to with questions and to help them navigate their day-to-day journey.

Because this role is so vital to the well-being of the larger community, there are some requirements that must be met in order to become an SGF:

• SGFs are required to host at least four meetings per year in person and/or virtually.
• SGFs are required to participate in MDF-led training; this year, an SGF training session is being held in Chicago from Friday, April 26 - Sunday, April 28, 2024 (while in-person is storngly preferred – MDF will cover travel expenses – attendance can be in person or virtual).
• SGFs are required to attend a monthly 1-hour SGF-only administrative group meeting.
• SGFs are asked, but not required, to attend the MDF Annual or Regional Conference each year.
• Meetings must adhere to certain guidelines and procedures. If selected to become an SGF, please note these guidelines will be reviewed with you prior to your first meeting.

Click here for a full list of requirements for MDF SGFs.

Are you able to make the following commitments? (Please check the box next to each statement below to indicate your agreement.) *

Please explain: * 

Please Explain: * 

MDF hosts virtual support group meetings via Zoom. Please rate your comfort and familiarity with Zoom: * 

Section 4: Support & Resources

Describe the kind of support and resources you would need to be effective in your peer support role: * 

Do you have any questions or concerns about becoming a SGF?