Mental Health Ambassador Program Application Form

Application Form

First Name

Last Name

Phone

Age

Gender

Preferred Pronoun

School and School District or College

Parent or Emergency Contact

Parent or Emergency Contact Email

Parent or Emergency Contact Phone

Parental Consent

I consent for my child to participate in the Mental Health Ambassador Program

I do not consent for my child to participate in the Mental Health Ambassador Program

I am above 18

Free Text

Short Answer #1: Please tell us why are you interested in mental health and wellness education. This may include any life experiences that you may have or any other personal experiences that you may have encountered.

Short Answer #2: The Mental Health Ambassador Program will include presenting in community wide events. This will involve preparation, organization, strong communication skills, public speaking, as well as empathy and compassion about the topic. Please share how does this fit your interests and experiences thus far.

Short Answer #3: What strengths do you have that make you an ideal candidate for this program and what do you hope to gain from this?