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Grief & Loss Counseling Group - Sign Up Request Form

Name*
First Last
Phone*
Email*
Newsletter Sign Up
- Subscribe me to HELP Center's monthly newsletter & program updates
Address*
Street Address Address Line 2 City State ZIP Code
When was the date of your loss?*
Briefly describe why you want to join this group.*
All information that you provide us will be confidential as required by state and federal law.
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Phone
This field is for validation purposes and should be left unchanged.

COVID-19 Anxiety Counseling Group - Sign Up Request Form

Name*
First Last
Phone*
Email*
Newsletter
- Subscribe me to HELP Center's monthly newsletter & program updates
Address*
Street Address Address Line 2 City State ZIP Code
Briefly describe why you want to join this group.*
All information that you provide us will be confidential as required by state and federal law.
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Individual Counseling - Sign Up Request Form

Name*
First Last
Phone*
Email*
We guarantee 100% privacy. Your information will not be shared.
Newsletter
- Subscribe me to HELP Center's monthly newsletter & program updates
Address*
Street Address Address Line 2 City State ZIP Code
Briefly describe why you are seeking counseling.*
All information that you provide us will be confidential as required by state and federal law.
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Transitioning Women's Support Group - Sign Up Request Form

Name*
First Last
Phone*
Email*
Newsletter
- Subscribe me to HELP Center's monthly newsletter & program updates
Address*
Street Address Address Line 2 City State ZIP Code
Briefly describe why you want to join this group.*
All information that you provide us will be confidential as required by state and federal law.
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Condom of the Month Club - Change of Address Request

Name*
First Last
Email
Old Address*
Street Address City State / Province / Region ZIP / Postal Code
New Address*
You must live in the DFW area to be eligible for this program.

Street Address City State ZIP Code
Phone*
All change of address requests will be voice verified.
Comments
This field is for validation purposes and should be left unchanged.

Condom of the Month Club - Cancelation Request

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
All cancelation requests will be voice verified.
Email*
We're sorry to see you go. Please help us improve our service by letting us know why you decided to cancel.*
Your responses will be kept confidential and will not be shared with any other party. Responses will only be used to help improve HELP's free Condom of the Month Club service.
Cancelation Reason - Other*
Please describe your reason.
Phone
This field is for validation purposes and should be left unchanged.

Join the Condom of the Month Club!

Condom of the Month Application

Name*
First Last
Address*
*You must live in the state of Texas in the DFW area to be eligible for this program.

Street Address Address Line 2 City State: Texas Only ZIP Code
Phone*
All online applications will be voice verified.
Email*
We guarantee 100% privacy. Your information will not be shared.
Email Newsletter Opt-in
- Subscribe me to HELP Center's monthly newsletter & program updates
Ethnicity*
Other Ethnicity*
Gender*
Other Gender*
Sexual Orientation*
Other Reason*
Age*
Birthday
MM
DD
YYYY
Consent
I agree to the privacy policy.
Comments
This field is for validation purposes and should be left unchanged.

Volunteer with HELP!

The Health Education Learning Project could not serve our community and implement the important programs we offer without a tremendous amount of volunteer support. Volunteer opportunities for each of our programs is different and varies according to the current program activities. Thank you very much for your willingness to help us achieve our mission by giving of your time.

Volunteer

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
May we leave a message for you at this number?*
May we send a text to this number?*
Is there a specific program or volunteer opportunity are you interested in?
What days/times are you available to volunteer?
- Weekdays
- Weekends
- Daytime
- Evening
- Anytime
Have you ever been convicted of a felony? (We are required to conduct background checks are required for some volunteer work)*
Are you required to be listed on a sex offender registry?*
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PREP SUCCESS RATE
IN THE PREVENTION OF
HIV TRANSMISSION

FREE CONDOMS
DISTRIBUTED IN 2021

FREE HIV TESTS
CONDUCTED IN 2021

PrEP PATIENTS SEEN
IN 2021

Grief & Loss Counseling Group - Sign Up Request Form

COVID-19 Anxiety Counseling Group - Sign Up Request Form

Individual Counseling - Sign Up Request Form

Transitioning Women's Support Group - Sign Up Request Form

Condom of the Month Application

Volunteer

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PREP SUCCESS RATE IN THE PREVENTION OF HIV TRANSMISSION

FREE CONDOMS DISTRIBUTED IN 2021

FREE HIV TESTS CONDUCTED IN 2021

PrEP PATIENTS SEEN IN 2021

Newsletter

PREP SUCCESS RATE
IN THE PREVENTION OF
HIV TRANSMISSION

FREE CONDOMS
DISTRIBUTED IN 2021

FREE HIV TESTS
CONDUCTED IN 2021

PrEP PATIENTS SEEN
IN 2021