The Gathering Application

Name

First Name

Last Name

Phone

(###)

###

####

Preferred Location:

How would you describe your cultural background?

Example: African American, Afro-Caribbean, Black African, Afro-Latinx, etc.

What drew you to The Gathering, and what do you hope to gain from participating?

💬 Every journey starts with a reason—what called you to The Gathering? What are you hoping to walk away with?

Acknowledgement: By submitting this form, I confirm that I am: 1. A Black individual who identifies as part of the Black community. 2. Able to attend all five sessions. 3. Open to participating in group discussions and completing between-session activities.

🔹 Important Note: The Gathering is a wellness offering focused on collective healing and personal growth. While it is facilitated by therapists, it is not a therapy group and does not replace individual mental health care.

I Agree