Thank you for your interest in bringing Send Silence Packing® to your campus or community! This program visits 15-30 communities per semester and we begin reviewing applications 6-8 months in advance. Please read hosting information carefully before submitting this form.Please Note: Submitting this Host Application DOES NOT guarantee you a spot on an upcoming tour. This application allows Active Minds the opportunity to learn more about your campus or community as a potential host site. Please complete each section in full to give us the best picture of your potential as a host. First Name Last Name What is your title/role at your organization? Phone Number Email School (No Abbreviations)/ Organization Name School/Organization Mailing Street School/Organization City School/Organization StatePlease 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 Organization website Zip Code Organization Type K-8 High School College/University Professional/Corporation Foundation Nonprofit/NGO Goverment/Military Healthcare or treatment center School System/District Are you an Active Minds chapter member or advisor?YesNoNo, but I would like to collaborate with an Active Minds chapterNo, but I am interested in starting a chapter Program Impact Please describe the need for Send Silence Packing in your community and the likely outcomes of an exhibit. Would you also be interested in booking a Speaking Event?Please select... Yes No Billing and Contracting Billing Contact First Name Billing Contact Last Name Billing Contact Title/Role Billing Contact Email Planning and Logistics Where would you host Send Silence Packing? Describe both the outdoor space and indoor rain location. What is the size of your proposed locations? Select the months you have available to host Send Silence Packing: January February March April May June July August September October November December Are there any school breaks, holidays, or other dates that you are absolutely unable to host the display during the timeframes you have selected above? Are there specific days where students are most likely going to be on campus? (i.e. commuter campus where most students take T/TH classes etc) Describe how you would advertise and promote the exhibit to your community. Is there anything else we should know about the challenges, opportunities, and potential benefits of bringing Send Silence Packing to your community? reCAPTCHA helps prevent automated form spam. The submit button will be disabled until you complete the CAPTCHA. Contact Information
