Reflective Practice Group Interest Form

Thank you for your interest in joining our King County Reflective Practice groups. Please fill out this short form to express your interest in participating. Please note this form is non-binding. The final groups will be determined based on the list of those who express interest and qualify.

First Name *

Last Name *

Email *

Profession *

Profession: Other (please describe)

Organization/Agency

Do you supervise staff who directly support families?

Yes
No

Age of Clients Served

4-5 years
Over 5 years
Prenatal to birth
0 - 3 years

Do you provide services in a mental health program? *

Yes
No
Unsure

Does your work primarily serve clients in King County (i.e., more than 50% of your clients)? *

Yes
No

Region(s) serving (select all that apply) *

Great Rivers (Cowlitz, Grays Harbor, Lewis, Pacific, and Wahkiakum Counties)
Greater Columbia (Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, Whitman, and Yakima Counties)
King (King County)
North Central (Chelan, Douglas, Grant, and Okanogan Counties)
North Sound (Island, San Juan, Skagit, Snohomish, and Whatcom Counties)
Pierce (Pierce County)
Salish (Clallam, Jefferson, and Kitsap Counties)
Southwest (Clark, Klickitat, and Skamania Counties)
Spokane (Adams, Ferry, Lincoln, Pend Oreille, Spokane, and Stevens Counties)
Thurston-Mason (Mason and Thurston Counties)

Please select the group that you would prefer to attend below. *

Arabic Group - 1st Wednesday of the month from 9:30-11:00 am
Arabic Group - 1st Thursday of the month from 11:30 am - 1:00 pm
English Group - 4th Monday of the month from 11:00 am - 12:30 pm
English Group - 1st Thursday of the month from 8:30 - 10:00 am
Spanish Group - 1st Wednesday of the month from 3:00 - 4:30 pm
Spanish Group - 1st Saturday of the month from 9:00 - 10:30 am

Timeout Warning

Reflective Practice Group Interest Form