Yale Wellness Reform Survey

NameOptional

First Name

Last Name

EmailOptional

example@example.com

Phone NumberOptional

Area Code

Phone Number

Twitter handleOptional

Facebook handleOptional

Yale Affiliation* This field is required.Required

Alumnus: I graduated from Yale.

Student: I'm currently enrolled at Yale.

Previous student: I completed at least one semester at Yale, but I am not currently enrolled and did not graduate.

I'm a family or friend of a current/previous student or alumnus.

Other

Name of the Yale student / alumnusOptional

First Name

Last Name

What school(s) did you attend / are you currently attending?Optional

Yale College

Yale Graduate or Professional School

Non-degree program at Yale

Other

Select the school(s) that your family member / friend attended.Optional

Yale College

Yale Graduate or Professional School

Non-degree program at Yale

Other

Class yearOptional. Multiple degrees? Enter the most recent class year.

Original class yearOptional

Do you want to share your or your loved one's personal experiences with mental health at Yale?Optional. Answering 'yes' to this question will prompt additional optional questions. Your responses are confidential and will not be shared without your consent.

YESNO

Did you or your loved one attend therapy at Yale?Optional

YESNO

Describe your / your loved one's experience with therapy at Yale.Optional

Did you or your loved one take a medical withdrawal at Yale?Note that a medical withdrawal is different from a leave of absence. A medical withdrawal happens after the first 15 days of the semester and requires a reinstatement / readmission process to return to Yale. A leave of absence must be requested during the first 15 days of the semester (or before). Leave of absences do not require an explanation and reinstatement is not required.

Yes

No, but the option was considered

No and the option was not considered

Why did you or your loved one not take the medical leave?Optional

Please describe the outcome with readmittance / reinstatement that you or your loved one experienced:Optional

Reapplied one time only and was granted readmittance / reinstatement the first time.

Denied readmittance at least once before being readmitted to Yale.

Denied readmittance one or more times and never returned to Yale.

Did Yale explain why readmittance / reinstatement was denied?Optional

YESNO

What would you like to share, about your/your loved ones experiences with contemplating withdrawal policies? What challenges did you face? What helped or would have helped? How was the experience with the medical withdrawal process and readmittance / reinstatement.Optional

Did any mental health support systems or leave practices at Yale leave a positive impression on you?Optional

What changes to mental health withdrawal policies or mental health practices at Yale in general would you like to see?Optional

How would you like to get involved?Optional (Scroll down to see all options)

I'd like to share my/my loved one's experience confidentially.

I'd like to share my/my loved one's experience publicly in writing. (Note, we will not share any details you provided without your consent).

I'd like to share my/my loved one's experience at a press conference.

I'd like to sign the Yale Wellness Reform petition when it is ready.

I'd like to share content on social media to help this cause, including petition, news articles, etc.

I'd like to donate to help Rachael's family.

I'd like to donate to help other students struggling with mental health issues at Yale.

I'd like to join an alumni group to provide emotional support to students struggling with mental health issues at Yale.

I'd like to assist with PR efforts.

I want to be involved, but I'm not sure how I want to help at the moment. Please stay in touch with me.

Other

How else would you like to get involved?Optional

What additional comments or condolences would you like to share?Optional

Do we have your consent to use the information you provided regarding your experiences with Yale Mental Health services in our advocacy efforts? We will not include your name without your express permission.

YESNO

Yale Wellness Reform Survey