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Youth Substance Use Prevention Support Form
Please answer the following questions about how you see your business supporting the Family campaign to the best of your ability. This campaign educates adults about the harms of youth substance use and offers guidance to have conversations with their children.
Thank you for your time and investment in the youth in your community to be substance-free!
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Business Name and Address
Your answer
Contact Person for Business (Name, Phone Number, and Email)
Your answer
What is the best way to reach you?
Phone
Email
In-person
Other:
Clear selection
The Family Youth Substance Use Prevention Campaign is a year-long campaign. Any support is greatly appreciated!
The following questions will help us understand how you would like to contribute to the campaign and help get the message out.
How would you like to contribute? Select all that apply
Hang print material at business/organization
Share or hand out print materials (i.e., with order pick-ups, deliveries, on counter etc.)
Share materials electronically (i.e., TV monitors, website, e-newsletters, social media etc.)
Donate a gift card
Donate product
Host an event
Other:
Frequency of support
1 time
Multiple times but less than monthly
Monthly
Other:
Clear selection
The following are the types of material: (All materials are offered in English and Spanish)
Stickers (4 x 4) any month
Poster (11 x 17)
Newsletter (8.5 x 11)
Info Card (5.5 x 8.5)
Social Media (any month)
Digital Displays
What material(s) would you like share? Select all that apply.
Social Media
Posters
Newsletters
Info Cards
Stickers
Digital Displays
Other:
Please share a couple of dates and times for someone to follow up to confirm your support and answer any of your questions.
Your answer
Do you have any questions or comments?
Your answer
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