Do you want me to visit your high school?
I lost my son, Charles to suicide while he was going through withdrawal and have since become a speaker on the subjects of mental illness, suicide and addiction at conferences, colleges and high schools. Please list your high school if you'd like me to reach out.
1. Please list your name here (optional)
2. Please list your email here (optional)
3. What is the name of the high school you wish to recommend? (Please list only one. Use the form again to list another if you have more than one.)
4. What is the address of this high school? (High schools outside the US are acceptable)
5. What is the name of the Headmaster/Head of school/Principal?
6. What kind of school?
Public High School
Private High School
Private Boarding High School
Private K-12 School
7. If you know it, what is the email of the headmaster/head of school/principal?
8. If you know it, what is the phone number of the office of the headmaster/head of school/principal?
9. If other in 6 above, please describe
10. Do you have a relationship with the headmaster/principal of this school? And if so, offer details and let me know if I can use your name and this information in the correspondence.
11. In your opinion, is it more important to lead with substance misuse or suicide prevention?
I don't know
12. If there is anything you'd like to add, you can comment here.
Never submit passwords through Google Forms.
This form was created inside of annemoss.com.
Terms of Service