Teen Mental Health Roundtable Application

Teen Mental Health Roundtable

Application
It's time to apply to the 2024-2025 BeWellATL Teen Mental Health Roundtable and provide insights to help the community understand what it really needs to support teen mental health.

• Serve as a member of our collective

• Share input about teen mental health needs

• Opportunities for leadership development

• Plan & participate in a Spring 2025 community-wide mental health event

• Establish connections & develop friendships with like-minded peers

2024: AUG 25 | SEPT 29 | OCT 27 | NOV 10 | DEC 15
2025: JAN 12 & 26 | FEB 23 | MARCH 23 | APRIL TBD | MAY TBD

APPLICATIONS DUE AUG 4
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Guardian Name

First NameLast Name
Guardian Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
High School*
Grade for the 2024-2025 school year*
Organizations Involved In
Synagogue Affiliation
Pronouns
Why do you want to be involved in the BeWellATL Teen Roundtable?*
What does the term “mental health” mean to you?*
What is one goal you have in being a part of this program?*
Anything else you would like us to know when considering your application?*
How did you hear about this program? If someone referred you, please include that person’s name here.*
Should be Empty: