iMatter Anti-Stigma Storytelling Interest Form

iMatter Anti-Stigma Campaign Background

Thank you for showing interest in sharing your mental health story. Please fill out the information below so we can contact you regarding your interest.

The iMatter Anti-Stigma Campaign aims to normalize discussing mental health in our community by sharing the stories of people who have overcome challenges with their own mental health.

The iMatter Anti-Stigma Campaign is currently supported by two grants in 2023 for Bay, Midland, and Saginaw Counties, but we still want to support you in sharing your story if you live outside of these counties:

The Midland Area Community Foundation ARPA grant will help reduce mental health stigmas and connect Midland County residents to local resources.
The Hemlock Semiconductor CARE Grant will help to normalize discussing mental health in our community by sharing the stories of residents who have overcome challenges with their own mental health.

All storytellers are required to be 18 years or older and sign an informed consent form which allows storytellers to remove their stories from our publications and communications at any time.

By submitting this form you agree to our Privacy Policy and Terms of Use.

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* 1. I am interested in sharing my mental health story:

Name

City/Town

County

ZIP/Postal Code

Email Address

Phone Number

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* 2. I am a resident or I am employed by an organization based in one of the following counties in the Great Lakes Bay Region:

Bay

Midland

Saginaw

I am resident or employed by an organization based outside of Midland, Bay, and Saginaw Counties

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* 3. What is your age?

18-24

25-34

35-44

45-54

55 and above

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* 4. Please specify your ethnicity:

Caucasian

African-American

Latino or Hispanic

Asian

Native American

Native Hawaiian or Pacific Islander

Prefer not to answer

Other (please specify)

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* 5. I am comfortable sharing my story in the following format(s) (select all that apply):

Video

Article

Live Event

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* 6. Below is a brief description of my mental health story:

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* 7. Would you like to be added to our email list for updates about the Great Lakes Bay Region Mental Health Partnership?

Yes

For more information about the Great Lakes Bay Region Mental Health Partnership contact Dr. Matt Samocki at msamocki@greatlakesbay.org, visit our website or follow our social media pages on Facebook, Instagram, and LinkedIn.

Click here if you would like to make a tax-deductible donation to help us advance anti-stigma and community culture, expand workplace mental health programs and enhance mental health provider access.

Stigma | Workplace | Access