Applicant Information

Thank you for your interest in attending The Active Minds Mental Health Conference, Be The Change, held in Washington, DC, August 2nd - August 3rd, 2024.

Please note: The Active Minds Mental Health Conference Stipends operate under a reimbursement structure.

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* 1. Full legal name as displayed on your government issued ID:

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* 2. If you would like to, share your pronouns here:
(ie. He, Him, His; They, Them, Their; She, Her, Hers; etc.)

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* 3. Which of the following populations do you identify with, if any? (Please select all that apply):

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* 4. What is the best email address we can reach you at? 

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* 5. Are you currently enrolled at a college or university?

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* 6. Institution (full name, no abbreviations, please):

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* 7. Anticipated Graduation Term and Year (i.e. Spring 2024):

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* 8. At the time of the conference, where do you plan to reside?

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* 9. Are you a part of the Active Minds chapter at your school?

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* 10. If you are a part of the Active Minds chapter at your school, what is your role? If you are not a part of the Active Minds chapter at your school, please list “N/A”

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* 11. How did you hear about the stipend opportunity?

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