1.Name

*2.What is your experience?(Required.)

A parent of a child with mental health challenges

A youth under the age of 30 with mental health challenges

3.Would you be able to attend monthly board meetings? Currently on a rotating schedule of an in person meeting in Middletown on the first Tuesday of the month & the next month meeting virtually on the first Thursday of the month.

Yes

No

4.Would you be able to volunteer for our annual Children's Mental Health Awareness Walk in May as well as at least two other events/activities?

Yes

No

5.Please tell us why you are interested in joining our board as well as what you could bring as far as your skills & abilities (ex. marketing, social media, organization, vocal/outgoing, advocacy, etc.)

6.Email Address

7.Phone Number