Thank you for taking a moment to complete this online form. We are here to help you and your organization. Please contact Cheryl.Gerstler@omh.ny.gov if you have any questions. 

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* 1. Name:

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* 2. Organization Name: 

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* 3. Email Address:

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* 4. Phone: 

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* 5. I would like to request the following NY Project Hope media materials:

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* 6. I would like to receive NY Project Hope educational materials for my organization via:

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* 7. If you would like to receive printed materials, please indicate:
*Quantity of each printed item requested
*Mailing address

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* 8. NY Project Hope offers educational presentations for students and staff on topics such as: Self-Care & Relaxation, Stress Management, NY Project Hope Overview, and more. Would you like to know more about scheduling a virtual or in-person presentation?

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* 9. Additional Comments:

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