CogWell School Interest Form
Thank you for your interest in CogWell's Listen Up Program! We are looking forward to connecting with you to offer support and resources for your campus.

Please fill out the following interest form so we can learn more about your school community. Your responses will not be shared, but kept internally to give us an idea about the needs of your school and how to proceed.

Thank you for working to support the students on your campus!
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Name *
Email *
School *
Position/Year *
How did you hear about CogWell's Listen Up programming? *
How great is the need for mental health support on your campus? Please explain. *
What level of mental health crises do you see with your students ? *
Required
What mental health and peer support programs already exist on your campus? *
Do you have any student-run mental health and/or peer support clubs on campus? *
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