Have you requested the Active Minds Peer Powered High School Curriculum before? Please select... Yes NoIf you submit this form even though you have already requested this, our system will not resubmit it. Please reach out to Youth Leadership department at k12@activeminds.org if you need the curriculum link again. Since you’ve already requested this curriculum, we don’t want you to duplicate your efforts. To receive the download again, please reach out to our Youth Leadership department at k12@activeminds.org, and we’ll make sure you get it to you as soon as possible. Name of School (No Abbreviations) School is a:Please select... High School College/University School System/District Nonprofit Other Name of District In which state is your district located?Please select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Other (Outside U.S.) Other State: School Contact First Name School Contact Last Name Email RolePlease select... Administrator Campus Wellness Staff Chapter Advisor Counseling Center Director Employee/Staff Faculty Student Title Is your school a Title I school? Please select... Yes No Does your school have an Active Minds Chapter?Please select... Yes No What setting do you plan on facilitating the Active Minds Peer-Powered Curriculum?Advisory PeriodHealth ClassAnother Class PeriodActive Minds Chapter meetingsAnother student organization meeting (please list)Other Other What grade level(s) do you plan on facilitating the curriculum with (check all that apply):9th10th11th12th Approximately how many students will receive the curriculum?
