Borough of Leonia - Mental Health Advisory Council Interest Intake Form

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The Borough of Leonia would like to ensure that we are providing all Leonians with information on the best available resources to ensure optimized mental health, especially during the COVID-19 Pandemic. To that end, we are asking Leonia residents who are also licensed mental health professionals to volunteer to come together (virtually), and as a group, determine the best "toolkit" that can be developed for use by our residents.

We will do this by conducting 1 - 2 webinar discussions, during which the professionals will be able to share their expertise on how to assist in this endeavor, and jointly, determine next steps for ensuring that the toolkit is developed as quickly as possible.

If you're interested in assisting in this critically important effort, please complete this form. We'll then be in touch with details on when the first webinar will be held.

Thank you for your help!

Leonia Resident First Name *

Leonia Resident Last Name *

Title (i.e. M.D., Ph.D., MSW, etc.) *

Mobile phone number (XXX-XXX-XXXX) *

email address *

I am interested in assisting with (check all that apply): *

Participating in virtual meetings (1 - 2 webinars) to identify best resources

Helping to lead the effort to assemble the "toolkit," and launching it to the public

Other:

Required

Questions/Comments (Optional)

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