Forum Registration

This forum is scheduled for March 22, 23, and 24, 2022 at 9:30 AM - 11:30 AM. As a participant of this community dialogue, you will be asked to share your opinions regarding Mental Health and Wellness. The Zoom link for the Forum will be sent to you the day before the event starts. 

Day 1: Listening Session (Khmer only) 
For anyone interested in local mental health advocacy! We want to hear from adult and elderly community members on their knowledge of and experiences with mental health services in Orange County. Join us to share your input about mental health challenges and ways to improve access to and quality of services.
This session will be conducted in Khmer.

Day 2: Advocacy Training for Adults/Elders (Khmer only) 
Part 1 of this advocacy training is for community members in Orange County who want to learn more about stakeholder engagement with their local mental health services. Participants will share and deepen their knowledge of mental health and practice effective communication and framing skills. This session will be conducted in Khmer.

Day 3: Advocacy Training for Adults/Elders (English with Khmer interpretation) 
Part 2 of this advocacy training is for community members in Orange County who want to improve their knowledge of local mental health systems and how to get involved. Participants will learn about the Mental Health Services Act, engage with decision makers, and learn about opportunities to share feedback.

PLEASE COMPLETE THE FOLLOWING SURVEY TO THE BEST OF YOUR ABILITY. YOUR RESPONSES WILL BE KEPT CONFIDENTIAL. THIS WILL HELP US ORGANIZE THE UPCOMING FORUM.

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* 1. Please enter your first name.

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* 2. Please enter your last name.

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* 3. Please enter your email address.

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* 4. Please enter your phone number.

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* 5. What city do you live in?

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* 6. What is your Zip/Postal Code?

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* 7. What is your ethnicity?

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* 8. Which day will you be attending? Please select all that apply.

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* 9. If interpretation or translation is needed, what language do you prefer?

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* 10. If you would like additional accommodation, please request them here.

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* 11. Do you consent to the event being recorded? The recordings will not be public and are for internal purposes only.

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* 12. Are you a public official?

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* 13. Questions & Comments

*Required Information

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This is the end of the survey. Thank you for answering these questions. We will be in touch regarding your eligibility to participate in the upcoming community dialogue/forum.

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