Gen-Z Speaks Wellness

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If you are a youth or young Black adult between 17 and 25 and live in Sacramento, Gen-Z Speaks Wellness is the perfect community capacity-building initiative for you. This program aims to promote mental health and wellness by providing culturally infused mental health convening, workshops, and safe spaces. If you want to be a part of this exciting initiative, sign up and complete the application today!

Email *

First Name *

Last Name *

Age *

Phone Number *

Address *

City *

Zip Code *

What is your race/ ethnicity?
*

What are your pronouns? *

She, Her

He, Him

She, They

He, They

They, Them

How did you hear about us?
*

Online

Through Personal Networks

CABWHP Website

Other:

Required

Why do you want to be a part of Gen-Z Speaks Wellness? *

What do you seek to gain from participating in Gen-Z Speaks Wellness?
*

Are you currently enrolled as a student?
*

Yes

If so, what school do you attend? N/A if it does not apply. *

Are you connected to a Black club/ organization on your college campus? If so, please share the club or organization. N/A if it does not apply.
*

Are you currently enrolled in a trade school or a specialized program? *

Yes

Are you currently in high school? *

Yes

If yes, what high school do you attend? N/A if it does not apply. *

Are you connected to a Black community organization? If so, please share the community organization n/a if it does not apply.
*

Have you already graduated from college? If so, what school did you graduate from? N/A if it does not apply. *

Are you employed? *

Yes

If yes, please share your organization/ employer name n/a if it does not apply. *

As part of Gen-Z Speaks Wellness, we will communicate via text message, phone and email. Do you consent to this?
*

Yes

What are your dietary needs? N/A if it does not apply.
*

Emergency contact first and last name *

Emergency Contact Phone Number *

Your Commitment

Gen-Z Speaks Wellness aims to create an environment for young adults to delve into various mental health topics and culturally relevant wellness models. The program also establishes a supportive community circle, fostering mutual support and encouraging young adults to advocate for improved resources and accessibility in the mental health field. In addition, it aims to increase access to and utilization of mental health services and care among young adults. Your dedication to creating a safe, friendly, and welcoming space plays a vital role in ensuring the success of the community circle, contributing to collective support and shared learning experiences.

Your commitment to Gen-Z Speaks Wellness:
*

I will ensure my application and the information contained herein is true and accurate.

I am dedicated to creating a safe, friendly, and welcoming environment to ensure the success of our community circle.

I will inform Gen-Z Speaks Wellness Staff if circumstances beyond my control impact my ability to engage in any workshop, activities, or assigned tasks/ roles.

I will complete all evaluation materials that will assist with maintaining the efficacy of Gen-Z Speaks Wellness and will share my experience to show why this program is important.

Required

Participant Signature (by typing your name below, you are signing your acknowledgment and acceptance of the participation agreement for Gen-Z Speaks Wellness.
*

Date of Signature
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YYYY

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