Skip to content
Teen Mental Health First Aid Interest Form
This form should be completed by school or organization leadership. Once submitted, you will hear back from MHANYS once the form is reviewed. This can take up to one week from completion.
*
1.
Email
(Required.)
*
2.
First and last name of primary contact person:
(Required.)
*
3.
Contact person email:
(Required.)
4.
Contact person number:
*
5.
Organization or School Name
(Required.)
*
6.
Organization Address:
(Required.)
*
7.
Is your site a school, youth-serving organization, community behavioral health center, or other? Select all that apply.
(Required.)
School
School District
Youth-serving Organization
Community Behavioral Health Center
*
8.
Is 10% of your adult staff trained in Youth Mental Health First Aid?
(Required.)
Yes
No
Unsure
9.
Is your site willing to have 10%of adult staff trained in Youth Mental Health First Aid?
Yes
No
Unsure
*
10.
Do you have interest from teens to provide Teen Mental Health First Aid?
(Required.)
Yes
No
Unsure
*
11.
Where does your site intend to teach or host Teen Mental Health First Aid?
(Required.)
At my organization/school
At an organization/school I plan to partner with
In the community
Other
*
12.
Select all that apply to your site.
(Required.)
Our goal will be to teach an entire grade level of teens at our site.
Our site has a protocol in place to respond to teens in distress.
Our site plans to teach tMHFA to grades 10, 11 or 12.
13.
Any other important details we should know about your initiative?
