Interest Form for Campus UnLonely

Interest Form for Campus UnLonely

Thank you for your interest in Campus UnLonely! Please complete the following form and we'll email you to talk further.
First Name*
Last Name*
Email *
example@example.com
Title*
Name of College or University*
Please spell out - no abbreviations, please
Your role/s on campus (choose all that apply)*

Health and Wellness staff on-campusStudent Affairs staffFaculty member or advisorResident Advisor (RA)Orientation Planning committeeStudentPeer mentorAdvisor (or oversight over) student peer mentorsAlumniNone of the aboveOther
College Location*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Is there a specific DEPARTMENT that will be responsible for delivering the Campus UnLonely programs?*

Student AffairsStudent Health and WellnessStudent SuccessN/A - not applicableOther department; please specify
Will the programs be delivered to students in a particular SCHOOL or COLLEGE (within a university)? If so, please specify which schools or colleges below.*
Which students will participate in the programs?*

UndergraduateGraduateStudents in a professional degree-granting programOther; please specify
What is the size of the school or professional program that will be using Campus UnLonely?*
What else are you doing to build connection on your campus?
What prompted you to reach out to us? Are there any particular student populations or groups that you are particularly interested in reaching? Or is there anything else you want to tell us?
Do you have funding available?*

Yes, I have funding availableMaybe, I might have fundingNo, I don't have funding
The Foundation for Art & Healing has multiple Membership Levels for campuses, with specific pricing and benefits for each one. We'll reach out to you with more details about these options based on the information you provided above. If you have a particular budget amount (or range) available to support this project, please let us know. If you don't have budget, please indicate that below along with any other additional information we should know. Thank you!
How did you hear about us?

artandhealing.org websiteSocial mediaFrom another college or universityOther
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