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The Common Room Membership Application

Thank you for your interest in The Common Room!

If you prefer, you can download an PDF version of the application here and email it to us at info@thecommonroom.org or send by postal mail to The Common Room, P.O. Box 459, Westwood, MA 02090

Your Name and Contact Information

Your Parent(s)/Guardian(s) Information
(if applicable)

Please select which of these two options bst decsribs tis person:
Which of these two options best describes this person?
If you give permission for The Common Room staff to communicate with your Parent(s), please check all that apply below, and provide your signature with date.

Your Demographic Information

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How would you describe youself? (check all that apply)
Diagnosis (if applicable, check all that apply):

Additional Membership Information

How did you hear about The Common Room?
Why are you interested in being a member of The Common Room? (Check all that apply)
What actitivies would you like to participate in with The Common Room? (Check all that apply)

Your References

Please provide two references we may contact to learn more about you and your interests. One can be a family member, but the second should not be a family member.

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