SHIFT Interest Form

Please fill out the following fields. You will then be prompted to schedule a confidential 15-minute meeting via phone.

Yes

Personally seeking support

Condition of divorce proceedings

Condition of child custody proceedings

Condition of Diversion or DPA agreement

Condition of criminal sentence

Another reason

My lawyer

Word of mouth

Internet search

BIP Provider list

Other

General Group (twice per week virtual group for 12 weeks)

Group Intensive (5-full day in-person sessions at Unfragile Farm, Sheboygan, WI)

Individual Intensive (5-full day in-person sessions at Unfragile Farm, Sheboygan, WI)

Not sure yet, I have questions.

I understand that program fees must be paid in full prior to the start of programming.

I understand that if I decide to do the 5-day Intensive option, there is an expectation that I will stay at Unfragile Farm for the duration of the program, or commit to participating in all programming throughout my program's duration.

If I decide to do the 5-day Intensive option, I understand that I'm responsible for the full cost of services, even if I decide not to partake in lodging or provided meals.

If I opt for the online group, I understand that I'll be required to participate in 2 hour sessions twice per week for 12 weeks via Zoom with reliable internet access on a computer with a camera and microphone. I am expected to be visible on camera.

If I opt for the online group, I am able to attend from a private location behind a closed door without others present or other distractions.

If I opt for the online group, I understand I must complete all 24 sessions.