Teen Lifeline Collective Partner Form

Join the Teen Lifeline Collective

Thank you for your interest in joining the Teen Lifeline Collective. Members offer mental health or wellness programs for youth ages 11–17 and are featured as trusted resources for youth and families. Please complete the form below to apply.
Organization Profile
Organization Name
Teen Lifeline Collective
Organization Employer Identification Number (EIN)
XX-XXXXXXXXX
Organization Type

Other
Website URL
https://www.website.io

Mission Alignment

At Teen Lifeline Collective (TLC), we harness the power of community to prevent teen suicide. Our mission is to improve mental health and wellness in adolescents (ages 11–17) by connecting young minds and their guardians to accessible community resources, while promoting resilience and empowerment
Your organization's mission statement
How does your organization's mission align with the goals of Teen Lifeline Collective?
What outcomes do you hope to achieve by joining Teen Lifeline Collective?
Do your services promote resilience and empowerment in teens?
How do your services promote resilience and empowerment in teens?
Does your organization offer mental health and/or wellness services to teens 11 - 17 years old?
What are the qualifications and credentials of your organization's staff or facilitators who will be involved in services for teens?
Please include any relevant certifications, licenses, or experience.

Organization Contacts
Primary Contact

First NameLast Name
Primary Contact Email
example@example.com
Primary Contact Phone Number
Format: (000) 000-0000.
Please let us know whom to contact regarding outreach event partnerships and collaborations.
Outreach Events Contact

First NameLast Name
Outreach Events Contact Email
example@example.com
Outreach Events Contact Phone Number
Format: (000) 000-0000.
Please let us know whom to contact if your organization would like to be invited to Collective networking events.
Networking Contact

First NameLast Name
Networking Contact Email
example@example.com
Networking Contact Phone Number
Format: (000) 000-0000.
Please let us know whom to contact if we wish to refer a family and their teen to your organization for mental health and/or wellness support services.
Support Contact

First NameLast Name
Support Contact Email
example@example.com
Support Contact Phone Number
Format: (000) 000-0000.
What financial assistance options, if any, do you offer to help clients access your services?
E.g., sliding scale fees, free services, scholarships, Medicaid/insurance accepted
How does your organization deliver services to teens in the Texas Hill Country and/or the Greater San Antonio Metro Area?
Physical Location(s) of Services/Resources in the Texas Hill Country and the Greater San Antonio Metro Area

Partner Interests
Which collaborative initiatives is your organization interested in?

Other
Is there anything else we should know about your organization or your interest in joining the Collective?
Should be Empty:

Organization Profile