Join for free Personal InformationYour REAL Full Name(Required) First Middle Last Gender(Required)Select a GenderFemale Male Non-IdentifyingBirth Date(Required) MM slash DD slash YYYY Race(Required)American Indian/Alaska NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Other Pacific IslanderWhite/CaucasianTwo or morePrefer not to answerThis field is hidden when viewing the formEthnicityYour email address(Required)Please check carefully. City(Required)State or Province(Required)Country(Required)Choose your CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweInformation about your lossWidowed Village verifies widowed status to ensure a safe space for widowed people.Please share your late loved one's full name.(Required)Please share the date of your loss.(Required) MM slash DD slash YYYY Were you widowed more than once?(Required) Yes No Please share your late loved one's full name.(Required)Please share the date of your loss.(Required) MM slash DD slash YYYY What was the cause of your person's death?(Required)Select a CauseAddiction COVID-19 Illness Sudden Suicide HomicideRelationship Type(Required)Select a TypeMarried: Opposite Sex Married: Same Sex Engaged/Life Partner: Opposite Sex Engaged/Life Partner: Same Sex Divorced then Widowed: Opposite Sex Divorced then Widowed: Same SexParenting Status(Required) Parent of minor(s) Parent of adult(s) No children Were you widowed while you (or your spouse) were pregnant?(Required) Yes No How did you hear about Widowed Village?Select a SourceSoaring Spirits International website Received Newly Widowed Packet At Camp Widow SSI Regional Group A friend's recommendation Funeral Home or Hospice Grief Counselor Online Search Adventist Health Simi Valley Simi Valley Police Department State Farm Insurance Agent Insurance Agent (other)Account InformationUsername(Required)Profile NameYour first name and the first letter of your last name is the default if none is selectedPassword(Required) Enter Password Confirm Password Strength indicator Receiving Broadcasts?(Required)This allows promotional emails from the website. Member information is never shared with a 3rd party. Yes No Receiving Emails?(Required)This allows the website to send emails regarding your password resets and actions regarding your posts/comments that occur within the website Yes No Allow members to send you messages?(Required)This option will allow other members to send you messages via the Widowed Village Messenger. Your email will not be visible within the Messenger. Yes No Widowed Pen Pal(Required)Would you like to be included in our Widowed Pen Pal program, which connects you with 1-3 widowed people of the same sex, for corresponding by phone, email, or in any other way? Note: This is NOT a dating service. Widowed Pen Pal is a database which "matches" your characteristics with others for friendship and mutual support. (You can opt in later if you change your mind by emailing contact@widowedvillage.org). Yes I'd like to be matched with a Widowed Pen Pal No thanks Verify Your Widowed Experience(Required)In order to become a member of Widowed Village, we must verify your widowed experience. Please include only one of the following forms of verification; obituary link, social media link, death certificate, or any document that verifies your relationship. Please note* sensitive information is purged from this website on a regular basis and never shared with a 3rd party* You may upload a copy of the death certificate with all personal information redacted, except for your name, your loved one's name, and the date of death. These details are the only information required for verification purposes Web Link Upload a File Other Verification via Web Link(Required)Please paste your link in the field belowVerification via File Upload(Required)Choose a file to uploadAccepted file types: jpg, jpeg, png, gif, pdf, doc, docx, Max. file size: 3 MB.Other(Required)Please describe your experience in the field below if you do not have a document or obituary to share that verifies your widowhood. Needs to show proof of your relationship.SSI Code of Conduct(Required)Please read the Soaring Spirits International Code of Conduct found on the link below and acknowledge your agreement by entering your full name hereDownload the General Code of Conduct Form, please click herePeer Support Acknowledgment(Required)Soaring Spirits International (SSI) provides peer support and community-based resources for widowed people, offering connection, hope, and resilience through shared experiences. However, SSI's programs, events, resources, and online forums are not substitutes for professional therapeutic or mental health services. If you are facing a crisis, experiencing acute emotional distress, or in need of immediate mental health support, we strongly encourage you to reach out to a qualified mental health professional or crisis intervention service. Soaring Spirits' programs are designed to sit alongside a whole system of support rather than function as a stand-alone resource, complementing personal and professional care where needed. By checking this box, I acknowledge the disclaimer noted above Anything else you'd like to share or ask?Would you like to add a statement about you to your profile page?For example, the URL of a blog? This answer will be VISIBLE on your profile page.CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
