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The Reclaiming Application

Thank you for taking a brave step toward reclaiming your voice. Please complete and submit this application to be considered for Voicelore’s first peer-led support group for survivors. A select number of applicants will be invited to a brief interview, after which group members will be chosen. Questions without an asterisk are optional. 🍃

General Information

Everyone in this peer-led support group must be 18 years or older. What is your age range?
18 or 19 Years
20 to 39 Years
40 to 59 Years
60+ Years
When is your birthday?
Month
Day
Year

We collect this information to verify your age group.

Accessibility

Do you use any assistive devices or technology to support communication, hearing, or vision?
How would you like to communicate during support group sessions? Select all that apply.
Do you have any other accommodations you would like us to know about? Select all that apply.

Survivorship

What forms of gender-based violence have you experienced? You are welcome to select as many as apply, even if you are unsure whether your experience “counts.”

If you are unsure of definitions, visit voicelore.org/get-informed.

Are you currently receiving counseling, therapy, or another form of professional support?

This information helps us understand how to best support you if difficult topics arise.

Briefly describe any strategies or supports you use so our peer facilitator can help maintain safety.


Group Logistics

This peer-led support group may include gender-based violence survivors of different gender identities. Are you comfortable participating in a mixed-identity space?
Virtual meetings, which start on January 11, 2026, will be held on Sundays from 3:30–5:00 PM PST (5:30–7:00 PM CST; 6:30–8:00 PM EST) via Zoom, except during Once Upon a Voice masterclasses and scheduled breaks. Does this fit your schedule?
If you are not initially selected for this group, would you like to be placed on a waitlist for future openings? New members may be invited to join throughout the year as space allows.

Participation

What tools or equipment do you currently have—or plan to have by January 11, 2026? Please select all that apply.

Not all of thes tools are necessary, but all are helpful.

Mandatory Reporting Disclosure

The peer facilitator is a mandatory reporter and must report concerns of physical harm to a minor or vulnerable adult if identifying information is known.

Community Disclosure

Voicelore’s support group is expressive and peer-led, not therapy. Participants are encouraged to seek professional or crisis support when needed.

Non-Profit Status Disclosure

Voicelore is not yet formally registered; this group is offered voluntarily without donations or fees until IRS approval is complete.

Optional Demographics

Which gender identity most accurately describes yours?
Male
Female
Non-binary
Other
Is your gender identity the same as the sex you were assigned at birth?
Which race or ethnicity best represents how you identify? You may select more than one if applicable.
May we include your responses anonymously in future advocacy reports or grants?

Signature

By signing below, you confirm that the information you have provided is accurate to the best of your knowledge and that you agree to the community policies outlined above.

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