Grief Support Group

Navigating Grief During the Holidays
Thursday, December 19
4:00 p.m.

* First Name

* Last Name

* Email

* Address (including city, state, zip code)

* Phone Number

* Date of Birth

Please select your preferred date

Thursday, December 19

As part of our grant reporting requirements and the work that Alexander JFS does in the community, we are requesting the following information. However, if you do not wish to complete this section, you can still sign up and attend the sessions.

Race

African American/Black African (Afroamericano/Negro Africano)Asian /Asian American (Asiático/Asiático Americano)Indigenous People or Native Americans (American Indian or Alaska Native) (Pueblos indígenas o nativos americanos (indios americanos o nativos de Alaska))Middle Eastern or North African (Medio Oriente o Norte de África)Multiracial (Two or more races) (Multirracial (Dos o más razas))Native Hawaiian or Other Pacific Islander (Nativo de Hawai u otra isla del Pacífico)White (Blanco)Not listed (No enlistado)Unknown (Desconocido)

Ethnicity

Hispanic Origin (Origen hispano/latino o español (cualquier raza))Non-Hispanic Origin (Origen no hispano/latino o español (cualquier raza))Prefer Not to Disclose (No quiero revelar)Other

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