Living Well with Chronic Conditions Registration

The Chronic Disease Self-Management Program (CDSMP) has enhanced the lives of hundreds of thousands of people around the world. This small group workshop will meet either in person or over Zoom for 6 weeks. The weekly sessions are highly interactive, focusing on building skills, sharing experiences, and support.

There is no fee for this program. As a participant, you will receive the CDSMP workbook to keep. Please provide your mailing address below so we can send you your copy. 

For virtual sessions, participants are required to:
- Join virtual sessions from a private area and maintain confidentiality
- Keep video cameras on for the whole session
- Have equipment and connectivity to join virtual sessions on Zoom, including a webcam

For ALL sessions, participants are required to:
-Attend at least 4 of the 6 sessions
-Maintain confidentiality 

CDSMP aims to help people and their caregivers control their symptoms, better manage their health problems, and lead fuller lives. Chronic conditions include: anxiety/depression, arthritis, autoimmune disease, cancer, diabetes, heart disease, lung disease, long COVID, and more. Learn more about the program here:  https://selfmanagementresource.com/.

Please complete the information below to register for a class:
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Mobile phone number
Address - street *
Address - city, state, zip *
How did you hear about this? *
Classes being offered (more workshops will be added as the year progresses): 

VIRTUAL: Begins May 28, 2025: Wednesdays from 9:30 am to noon, ends July 2. Leaders: April Payne & Paige Riddle

VIRTUAL: Begins August 27, 2025: Wednesdays from 9:30 am to noon, ends October 1. Leaders: Brandi Pettey & Kristen Gibson

VIRTUAL: Begins October 17, 2025: Fridays from 1 pm to 3:30 pm, ends November 21. Leaders: April Payne & Emily Jacobs
Please indicate your first and second class choice:
First choice
Second Choice
VIRTUAL: May 28 on Wednesdays from 9:30 am to noon through July 2
VIRTUAL: August 27 on Wednesdays from 9:30 am to noon through October 1
VIRTUAL: October 17 on Fridays from 1 pm to 3:30 pm through November 21
If none of these times work for you, please let us know when a good time for you would be and we will contact you when a class is available. 
If joining a VIRTUAL session, I understand that this is a virtual program held via Zoom. I have the equipment and connectivity to join the session each week. *
I am available to attend at least 4 of the 6 days for the program I requested. *
If joining a VIRTUAL session, I will join sessions from a private area. *
If joining a VIRTUAL session, I understand that I am expected to keep my video on during sessions. *
 I will maintain confidentiality of the other participants.
 *
Next Steps
We will review make every effort to accommodate your first choice. Because class sizes are limited to 12 participants, we may not be able to accommodate everyone's first choice. However, we will offer additional classes in the future. Thank you for your interest!
Questions? Contact your extension agent or course leader: 


Aisha Salazar, Extension Agent, Arlington | asalazar@vt.edu

Andrea Haubner, Extension Agent, Wythe | andreah1@vt.edu 

April Payne, Extension Agent, Spotsylvania and Stafford | arpayne@vt.edu

Brandi Pettey, Extension Agent, Lee and Scott Counties | bnpettey@vt.edu    

Emily Jacobs,  Nutrition Educator, Loudoun County | Emily.Jacobs@loudoun.gov

Jessica Jones, Extension Agent, Greensville/Emporia, Dinwiddie | jessicaj19@vt.edu 

Katie Strong, Extension Agent, Fairfax | kstrong@vt.edu

Katrina Kirby, Extension Agent, Petersburg | kirby2@vt.edu 

Kristen Gibson, Extension Agent, Russell | kbgibson@vt.edu

Paige Riddle, Extension Agent, Northwest District | arpaige@vt.edu

Elizabeth Caton, Department of Population Health Sciences, Virginia Tech | ecaton@vt.edu

If you are a person with a disability and desire any assistive devices, services, or other accommodations to participate in this activity, please contact Elizabeth Caton five days prior to the event at 540-231-1837/TDD*(800) 828-1120 during business hours of 8 a.m. and 4:30 p.m., or by email at ecaton@vt.edu, to discuss accommodations.

A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Virginia Tech.

Does this form look suspicious? Report

Google Forms