Please fill out this form if you would like to add your self-help support group to our database or change the description of a group already listed.

Form fields with an asterisk (*) are required to be filled in.

If you prefer, you can request a copy of this form by sending an email to njgroups@mhanj.org 

OUR DEFINITION OF A SELF-HELP SUPPORT GROUP

♦ Mutual aid, members helping members, is evident
♦ Composed of peers (persons sharing a similar life situation)
♦ Primarily run by and for the members who have a sense of ownership of the group
♦ Group is voluntary and non-profit. There are no fees for service (but minimal donations are fine).

Groups not included: Civic, ethnic, fraternal, housing, cultural, political, church or neighborhood.

Support Group Form

First Name *

Please enter your first name!

Last Name

Enter your last name

Agency

If Applicable

Your Mailing Address *

Enter your mailing address

City *

State *

Zip Code *

Phone *

Including Area Code

Email *

Please enter your email!

Website

Enter Website URL if you have one

Group Name *

Group Status *

New

Existing

Group Description *

Enter a general description of your group including mission, goals, activities

Any Cost? *

Yes

No

Cost Explanation

Explain the reason for dues

Meeting Day *

Meeting Time *

Meeting Location *

County *

Group Contact Person *

Additional Notes

Your Relationship to the group *

i.e. Founder, Leader, Member, etc.

Text

Check here if to verify you have answered these questions to the best of your knowledge. If this is a new group, we will contact you before publishing it online.

Verification *

Yes

Security Code *

Security code is not correct

Send me a copy