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Youth Mental Health Leadership CouncilĀ 
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Name of Youth
Date of Birth
School and Grade
Phone number (if applicable)
Caregiver Name (Parent/Guardian) Emergency Contact
Caregiver (Parent/Guardian) Phone Number
Why are you interested in being part of this leadership council?

Why do you think Mental Health awareness is important?

What resources are needed for those who experience mental health?

Is there anything else you would like us to consider as we develop this council?

If you have any other questions or concerns please reach out by email to or text 1(831).837.7032 with code YMHLC

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