Barber & Beauty Shop
Behavioral Health Listening Sessions
Name
First Name
Last Name
Email
example@example.com
Shop Name
Shop Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If funded, is this the shop location services would be provided? If not,or multiple locations, where would services happen?
Phone Number
Please enter a valid phone number.
Website
Social Media
Are you interested in providing or accessing Behavioral Health services in your local Barber/ Beauty Shop.
Yes, provide services
Yes, access services
Not Sure
I don't see the value
Can we contact you via email to interview you for this process?
Yes
No
Are you interested in being funded for providing Behavioral Health Services at your Barber/ Beauty Shop for this Statewide process?
Partnership is required if funded, so remember, there will be collaboration work happening statewide as a funding requirement.
How would you envision Barber and Beauty Behavioral Health projects supporting your community(ies) needs?
What would this look like being implemented and ran successfully in your opinion?
If funded, do you have the capacity to work with other Barber and Beauty Shops on the Strategies and Supports being developed for implementation within this project?
Collaboration will be required and written in to each contract funded.
Submit
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