Extended Family Information Form

The Extended Family Program creates small, intentional, intergenerational "mini-communities" within our larger congregation. Each Extended Family consists of about 10–15 people (including children) who commit to meeting regularly to share meals, celebrate life milestones, explore shared interests, and support one another through life's ups and downs. These groups are autonomous and self-governed, focusing primarily on deepening interpersonal connections and weaving a strong web of community.

Purpose of this Form

This form helps the planning committee thoughtfully place individuals and households into their Extended Family. By sharing your living situation, logistics, and interests, you help us create a well-balanced, accessible, and vibrant family. All information provided will only be used for family placement.

1. Primary Applicant Demographics

If participating as a household, please designate one primary contact.

Full Name

Pronouns

Gender

Age

Street Address

Email Address

This address will receive a confirmation email

Phone

2. About Your Household

What is your current living situation? Do you live alone, with children, with a partner/ spouse/ other adults or relatives?

Will anyone else in your household be participating with you? If yes, please list their details below:

Name/ Pronouns/ Gender/Age

3. Hopes & Intentions

What would you like to give and receive as a member of an Extended Family? (e.g., building casual friendships, creating intergenerational connections, finding deep social support, sharing meals, etc.)

Do you have any concerns or apprehensions about joining an Extended Family? (Sharing this helps us support your group’s Family Organizer during the initial kickoff phase).

4. Accessibility & Logistics

Meetings typically occur in members' homes or other locations decided upon by the group.

Transportation: Do you have any transportation concerns or limitations we should take into account when placing you in a group?

Allergies: Do you or anyone in your household have severe allergies (food, pets, environmental) that group hosts should be aware of?

Thank you for your interest! Don't forget to join us for the Kick-Off Potluck on Sunday, August 30th to meet potential group members and learn more! If you have any questions please reach out to connectionschair@uusalem.org.

Description

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Extended Family Information Form

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