Share Your Mental Health Story

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Do you have a personal experience with mental illness that you would like to share with others? Would you like to serve as a guest speaker or panelist at one of our workshops? We would love to hear from you! Fill out this simple form so we may contact you with ways to get involved with Stamp Out Stigma Inland Empire. You can also choose to anonymously share your story and we will post it to our website.

Who is your story for? *

Would you like to serve as a guest speaker or would you prefer your story to be shared anonymously on our website?

I would like to serve as a guest speaker or panelist.

I prefer to remain anonymous, but you can share my story on the Stamp Out Stigma Inland Empire website.

Who is your story about? *

This will help us identify our target audience for our workshop or panelist presentation.

Myself, I would like to share my own personal experiences with a mental illness.

A friend, relative or loved one who has a mental illness.

Myself, I am a professional mental health care provider.

What is your story about? *

This will help us narrow down the overall theme of our presentations.The following is a general list of categories, it is in no way an exhaustive list of the topics you can talk about when you share your story.

Depression

Suicide

Anxiety

Bipolar Disorder

Schizophrenia

Post Traumatic Stress

Eating Disorder

Self-Injury

Substance Abuse

Other:

Required

Please provide a brief introduction to your story. *

If you prefer to remain anonymous you may paste your entire story within the text box.

Please describe any previous public speaking experience.

This is only necessary if you are interested in serving as a guest speaker or panelist.

May we contact you?

Leave your email address and/or phone number so we can get in touch with you on how you can share your story at upcoming Stamp Out Stigma Inland Empire events.

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