Stand for Children, America
I am requesting that you add my name, title, affiliation, and location, as they appear below, to the letter "Stand for Children, America" by Chandra Ghosh Ippen (
Sign in to Google to save your progress. Learn more
First Name
Feel free to add initials or middle name as well
Last Name
Title and affiliation as you want it added
2 letter abbreviation in CAPS preferred
We will use this to generate a map of those who are partnering for children
Occupation (optional, if not already included as part of title and affiliation)
(e.g. Infant and Early Childhood Mental Health Consultant, Psychologist, Social Worker, Occupational Therapist, Teacher , Foster Parent . . . )
We will not share your email address
Country (ONLY if outside the United States)
Would you like to be contacted by us regarding future opportunities for action?
Clear selection
Is this a new request to be added to the letter, or are you updating your information since we asked for zip codes?
Clear selection
Anything else you would like us to know?
Clear form
Never submit passwords through Google Forms.
This form was created inside of UCSF Child Trauma Center. Report Abuse