MILES HALL YOUTH SUMMIT: BREAKING BARRIERS TO BLACK MENTAL HEALTH school administrator interest form

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MILES HALL YOUTH SUMMIT: BREAKING BARRIERS TO BLACK MENTAL HEALTH school administrator interest form

Educators: Please complete this form indicating how many students you wish to sign up.

Email *

Name of High School *

Name of Educator/Administrator submitting form
*

Your Title
*

Your Email Address
*

Your Phone Number
*

Number of students attending (please enter numbers only)
An estimated number is fine at this time. We will be following up to get names, emails and other information about participating students closer to the event. *

Number of chaperones attending (please enter numbers only)
*

How Your Students Will Get To The Summit
*

A copy of your responses will be emailed to the address you provided.

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