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Club Program Application Form
Club Application Form 2020-2021
Name
*
First
Last
Email
*
Full Name of High School
*
Which BC2M region is your school located in?
*
Northern California
Southern California
Arizona
Indiana
Ohio
New York City
Northeastern States (NY, NJ, CT, PA, VT, MA, ME, NH,DE, RI, MD)
Other
City and State of School
*
Your Position within the School
*
Student
Teacher
Counselor
Psychologist/Social Worker
Administrator
Other
Please list your position within the school:
*
Why are you interested in launching a BC2M club at your school?
*
Currently how is mental health talked about at your school and within your community? How would you like this to change?
*
Is there a group of pasisonate student leaders ready to launch this student-led club? Please describe.
*
Please share email addresses for students and staff interested in participating in a future BC2M club at your school?
*
Please separate emails with a comma.
How did you first hear about BC2M?
*
Learn
About BC2M
About Mental Illness
Our History
Our PSAs
Our Team
Impact Report
Undergrad Research
Talk
Blog
Stories
Videos
Share
Choose Your Words
Talk Tool
Get Involved
High School Program
Plan an Event
Strategic Partners
Donate
