Gift From Within PTSD Resources for Survivors and Caregivers
							Therapists Click Here to Join
		Support Pal Patti & her enthusiastic assistant, Charlie. Manager of Writer's Group & GFW's support pal network.

We are a non profit organization. We would appreciate a donation of $5. Please send a check, money order, or use Pay Pal.

Mental Health Professionals: You are also welcome to join if you are a trauma survivor.

For Men: If you've experienced the following.....sexual assault, physical abuse, trauma from being robbed, beaten, REMEMBER....YOU ARE NOT ALONE....the following sites could be most helpful for you: For Men Only

All names are kept strictly confidential. GFW may contact you by email or phone. After receiving our guidelines via email, please contact Joyce or Patti for a phone screening. Joyce can be reached at joyceb3955@aol.com and Patti at pattipott@aol.com

At present, the Support Pal Network is not accepting people who are currently incarcerated and/or in psychiatric hospitals.

I understand that by signing this release form that:

• GIFT FROM WITHIN will assist me in finding an email support pal.
• GIFT FROM WITHIN will create a short biography based on my completed form that will be shared with members only.
• GIFT FROM WITHIN will keep my name, bio, and address confidential within the support pal network.
• GIFT FROM WITHIN will send me names and addresses after I return the questionnaire and complete a telephone screening with Joyce Boaz.
• GIFT FROM WITHIN may from time to time send me questionnaires that will be computerized and only used for scientific studies on PTSD. I hereby authorize the use of such questionnaires that I may sign for such purposes.

As a GFW Email Support Pal, I agree to the following:

1. All names will be kept confidential;
2. That I will not hold GFW or its Board Members responsible or liable in the event that the relationship does not work, no matter the reason. I understand there are no guarantees and some risk is involved.
3. I understand that a support pal could say something during our correspondence or communications that could be triggering and I need to be mindful of my own needs and limitations. I will also behave kindly and gentle towards others, remembering we are all in this together.

Please provide:
Personal History: name, age, gender, traumatic experience, why you want this service. (Some of this info will be shared with members only)

Please print: (or click here for printer friendly page)

Date_________________________________

Name____________________________________________________

Address_______________________________________________________________

City___________________________________ State________ 

Zip________________ Country ____________________

Why I want this service (include traumatic event) ____________________________________

_______________________________________________________________________________________


Occupation__________________________________________________________________


Hobbies and/or things that I enjoy___________________________________________


How did you find us?_________________________________________________________ 


Birthday_______________________ | Age____________________

Language Preferences
(bilingual helpful)__________________________________


Phone______________________________________________  Email: ________________________


Your signature___________________________________________________________


Witness________________________________________________________________

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