Black Therapist Podcast New Form
Hi I am sending you this correspondence in response to your request to be featured on an upcoming Episode of the Black Therapist Podcast. Currently our Podcast has a growing list of subscribers and to date over 50,000 listens and growing every single day. We are evolving and would like to feature more therapist of color all across the country so we can be a resource to people who look like us and are struggling to find help to deal with their mental health challenges. Please fill out this brief survey so I know how to better place you on our production schedule and how best we can help you and be in service of our audience. I appreciate your interest, and look forward to fellowshipping with you.
Email address *
What is the phone number you would like to be contacted on? A landline is preferred and/if not please be in a stationary, quiet environment for interview.
Your answer
What is your Name and Credentials/title at the organization? *
Your answer
What does your organization to help the community at large?
Your answer
Does your organization do to further mental health initiatives for people of color? If so based around what topic? *
Your answer
Who is your target population *
Your answer
Are you Certified or Trained In any Specialty areas? If so what
Your answer
Do you have anything specific or time sensitive to promote on the show? If yes what?
Your answer
What is your passion project relating to mental health/advocacy/wellness/social justice? *
Your answer
Please list all social media handles
Your answer
Will you be willing to promote and/or share your feature across your social media platforms? *
Provide a link to your bio or cut and paste
Your answer
Can you provide a photo prior to interview so we can design the social media promotions? Professional Photos work best but not necessary
Have you listened to the show prior to submission?
If you have listened please feel free to provide general feedback regarding the show if you have any...we are a work in progress.
Your answer
Do you have a quick mental health/social justice tip to share to our listeners you would like to submit? This will be a feature on one of our upcoming shows and if we don't use you right away for our one on one interviews will may use your tip and give a shout out to your practice name and location on an upcoming show *
Your answer
Do you weekend availability on Saturday/Sunday mornings in the coming weeks? As we plan our calendar we will reach out with possible recording dates and air dates. Please contact us directly via email if you need an alternative scheduled date. *
How does being a person of color inform your practice or affect your work with the population you serve? *
Your answer
Are you willing to or have you/written a comment or provided feedback on our itunes page or across any other podcast platform? If you have not please consider doing so. Thank You for your Interest.
Your answer
PLEASE SUBMIT TO SEND A COPY OF YOUR RESPONSE TO YOURSELF AS I HAVE HAD ISSUES WITH FORMS IN THE PAST. PLEASE INDICATE YOU HAVE READ. *
Your answer
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