Complimentary Peer Support

Peer Support Application

Thank you for taking this step. Your answers help us match you with grounded, non-judgmental support that honors who you are and where you're going.

You are not alone. You are becoming.

Client Information

Full Name *Preferred Name Pronouns Phone Email *City / State

About You

1. Tell us a little about yourself. *Your personality, values, or what keeps you grounded.2. What made you seek peer support at this time? *3. What are the main challenges you're navigating right now? *

Support Needs & Goals

4. What type of support are you looking for? * (Check all that apply.)

Other

5. What does feeling supported look like for you? *6. What goals would you like to work toward with peer support? *

Your Emotional Wellness

7. How do you usually cope when you feel overwhelmed? *8. What helps you feel calm or grounded? *Examples: breathing, journaling, movement, quiet time.9. Are there topics or situations you prefer not to discuss?

Communication Preferences

10. How do you prefer to communicate? *11. How often would you like check-ins? *12. What communication style feels safest and most supportive for you? *

Boundaries & Safety

13. What boundaries help you feel comfortable in a support relationship? *14. How do you want your peer supporter to respond when you're having a difficult day? *15. If you ever feel unsafe or in crisis, who is a trusted person or resource you can reach out to? *You may list a friend, family member, mentor, or professional.

Crisis-Safe Awareness

Peer support is not a substitute for professional or emergency care. This section helps us understand your comfort level.

16. Have you ever worked with a therapist, counselor, or support group? *17. What helps you feel safe during emotional conversations? *

Alignment With Peer Support

18. What does authenticity mean to you in a support relationship? *19. What do you hope to gain from being part of Nouveau Connexion's peer support community? *

Final Acknowledgment

I understand that peer support is based on shared humanity, grounded presence, and healthy boundaries. I commit to engaging honestly and respectfully within this support relationship.

Signature (type your full name) *Date *

Your application is sent securely. We'll review and reach out within a few days.