BMH Fellowship Host Site Interest Form

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Thank you for taking time to fill out this interest form! This form is specifically for organization's who wish to serve as host sites for the Black Mental Health Fellowship Program. Please feel free to reach out to blackmentalhealth@imha.ngo for any questions related to this form or program.

Name *

Email *

Gender Pronouns *

Name of Proposed Host Site *

Where is this site based? *

Africa

The African Diaspora

We have offices both on the continent and throughout the diaspora

Other:

Required

In a few words, describe your proposed host site's mission. *

Let us know why you think this site would be a great fit for the Black Mental Health Fellowship Program. *

Who would be the ideal fellow for to join your team right now? *

Any other thoughts, questions or ideas welcome here.

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