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School Champion Registration
*Please note: The deadline to receive Awareness Items has passed, but please still register as a School Champion and receive our digital materials.
Thank you for helping your school to be a Children's Mental Health School Champion! Please fill in the information below to join the Campaign.
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First Name
*
Your answer
Last Name
*
Your answer
Work E-mail
*
Your answer
Work Phone Number
Your answer
Position Title
*
Your answer
Work Address
*
Your answer
Please use the spaces below to indicate the name of each school which you are registering to join the Campaign.
School 1 Name
*
Your answer
School 1 total student population
*
Your answer
School 1 total number of personnel:
*
Your answer
School 2 Name:
Your answer
School 2 total student population:
Your answer
School 2 total number personnel:
Your answer
School 3 Name:
Your answer
School 3 total student population:
Your answer
School 3 total number of personnel:
Your answer
Name(s) of any additional schools registering, total student population and total number of personnel:
Your answer
My school(s) is:
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Public
Private/non-public
Head Start/Early Childhood
Charter
Other
Select the county of your school(s):
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Choose
Allegany County
Anne Arundel County
Baltimore City
Baltimore County
Calvert County
Caroline County
Carroll County
Cecil County
Charles County
Dorchester County
Frederick County
Garrett County
Harford County
Howard County
Kent County
Montgomery County
Prince George's County
Queen Anne's County
Saint Mary's County
Somerset County
Talbot County
Washington County
Wicomico County
Worcester County
Is your school(s) active on social media? If so, please provide your URL or username for Facebook, Twitter, etc.
Your answer
How did you hear about the Campaign?
Past participation
Colleague/co-worker
My principal/supervisor
County-level school administration
Directly from Children’s Mental Matters! Campaign
Mental Health Association of Maryland (MHAMD)
Maryland Coalition of Families (MCF)
MSDE
National Center for School Mental Health
MANSEF
Community organization
From social media
Other:
Awareness Materials
*The deadline to receive Awareness Materials has passed!
While supplies last, each registered School Champion site is eligible to receive up to 1 poster, 15 Wristbands, 15 mood pencils and bookmarks for each student.
I will pick up my Awareness Materials at the following location. Pick up dates/times during the first week of April will vary by location.
Choose
Baltimore City: MCF Baltimore Office, 2701 N. Charles Street, Ste. 400, Baltimore, MD 21218
Columbia: MCF Central Office, 10632 Little Patuxent Parkway, #234, Columbia, MD 21044
Eastern Shore: MCF Caroline County Office, 9 South Third Street, Denton MD 21629
Eastern Shore: MCF Salisbury Office, 212 West Main Street, Suite 202B, Salisbury, MD 21801
Lutherville: MHAMD Office, Heaver Plaza, 1301 York Road, Ste. 505, Lutherville, MD 21093
Prince George's County Public Schools: delivery to school site via School System Pony Mail
Prince George's County: Judy Hoyer Family Learning Center, Office of Psychological Services, 8908 Riggs Road, Adelphi, MD. Pick up 8:00 am - 3:00 pm, April 2-5
Southern Maryland: MCF Southern Maryland Office, 25484 Point Lookout Road, Building 3, Unit 303C, Leonardtown, MD 20650
I will NOT pick up Awareness Materials
My school(s) would like to receive Spanish-language Campaign materials for parents and caregivers.
Yes
No
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