Liaison Interest Form
#Out4MentalHealth is seeking LGBTQ advocates who are passionate about mental health to sign on as local liaisons with our campaign. Local liaisons will be a crucial part of the #Out4MentalHealth team: supporting the project’s education, outreach and advocacy goals; providing feedback; and being among the first stakeholders to learn about project activities as they launch.

We are looking for liaisons in all parts of California, with diverse representation from each of the Mental Health Regions.

Liaisons commit to the following tasks for duration of the three year project:
• Attend at least one #Out4MentalHealth town hall in their region
• Publicize #Out4MentalHealth training in their area via email and by disseminating flyers to local partners
• Share about the #Out4MentalHealth project during local networking opportunities
• Update the #Out4MentalHealth team regarding resources in their area
• Document their project participation

Benefits for liaisons include:
• Opportunities to network with statewide LGBTQ and mental health organizations
• Opportunities to engage in policy advocacy and local resource building
• Liaisons will receive full scholarships, travel, and lodging to attend the #Out4MentalHealth state wide LGBTQ mental health convening in year two of the project

We want your voice! If you are interested in making a difference for LGBTQ mental health, please fill out this liaison interest form and Mandy Taylor will be in touch within 3 business days.

Email address *
First Name *
Your answer
Last Name *
Your answer
Phone # *
Your answer
Mental Health Region *
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County *
Your answer
Age Group
Sex Assigned at Birth
Current Gender Identity
What pronouns do you use?
Your answer
How do you identify your race/ethnicity?
Your answer
What is your romantic and/or sexual orientation?
Your answer
Why would you like to be an #Out4MentalHealth Liaison?
Your answer
What strengths and skills would you bring to the project?
Your answer
What challenges do you foresee?
Your answer
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