Request for Services What service are you interested in?* Counseling and Community Support Mentoring Parenting Classes Training Services for your school building We’re sorry but at this time we are no longer accepting new psychiatry clients. Are you interested in becoming a program partner? Yes No Are you interested in having a staff member speak about the program at your organization? Yes No Are you interested in becoming a mentor? Yes No Are you interested in mentoring for your child? Yes No Tell us more Counseling and Community Support Services* Adult Child Name of School Building*Presenting Problem Select All Depression Anxiety Psychosis Anger/Aggression Mood Swings Trauma/PTSD Grief/Loss Eating Disorder Attention/Concentration Issues Behavior Issues Marital/Relationship Concerns Additional Needs or Concerns Select All Legal Financing Housing Food Instability Requesting Help WithAre you interested in becoming a mentor? Yes No Are you interested in mentoring for your child? Yes No Select your desired service: Suicide Prevention Trauma-Informed Training Mental Health First Aid Name First Last PhoneEmail I prefer to be contacted by: Phone Email Δ