Application

Application

Anti-Carceral Mental Health Response Program
Access note: If any part of this form is inaccessible to you, please e-mail support@projectlets.org. We welcome alternative forms of submission, and you may send an audio or visual recording to sarah@projectlets.org with the subject: Application Submission
Basic Info
Name

First NameLast Name
Pronouns
Email
example@example.com
Please confirm that you are not a licensed clinician or are in the process of obtaining licensure (for example: LCSW, LMHC).
Please confirm your availability for all of the following program times/dates:
Do you anticipate any barriers to attending scheduled program meetings?
Location
The purpose of the Abolitionist Mental Health Response Program is to develop geographically local organizing and carework hubs. Which of the following geographic hubs would you consider yourself local to?
What city do you live in?
Do you intend on remaining local to the area for at least the duration of this program (insert dates here)? For example, do you plan on moving away from this general area within the program timeframe?

Other
If you clicked "other", please explain:
Application Continued
Please select any/all spaces or places you wish to apply what you learn in this program
If you clicked "other", please explain:
Are you connected with any existing organizations, organizing groups, or mutual aid networks? Please list! Note that you don’t have to be already connected with a group to be considered for this program. One of the major intentions of this program is to foster those connections that don’t already exist. If you’re not connected to a group in some way, that’s alright!
Short Response Questions

The following are short-response questions. Your responses don’t have to be formal or polished! We care most about learning more about you and how you approach this work - not about grammar or length. Please keep each response under (roughly) 250-300 words.
The Abolitionist Mental Health Response Program seeks to organize and resource Mad & Disabled careworkers. We define “carework” broadly and it can range from conversations in a barbershop, to caring for a family member, to organizing community events, to providing rapid responses to people in crisis. How do you currently practice or relate to carework?
What is your relationship to Madness, psychiatric survivorship and/or disability? Are there other identities or experiences you hold that show up or are central to your carework?
What do you hope to get out of this program? Why are you applying?
If given the opportunity to connect with others locally around abolitionist, anti-carceral carework, what would you like to build together?
Opportunity to share access needs
Optionally, feel free to share any access needs you anticipate for participation in the program. This is not used to evaluate your application in any way. We view accessibility as a continued conversation, and if selected, there will be further structured and unstructured opportunities to share access needs to ensure the program is accessible to you.
Should be Empty:

Application

Basic Info

Location

Application Continued

Short Response Questions

Opportunity to share access needs