Name *

Pronouns *
- Select Option She/Her He/Him They/Them Not listed Please specify a value for Pronouns

Email *

Major *
- Select Major Accounting Acute Care Ped Nurse Prac Administration Administrator-Business Manager Administrator-Central Office Administrator-Elementary & Secondary Administrator-Elementary Principal Administrator-Secondary Principal Administrator-Superintendent Adult Nurse Practitioner Adv Intcu Fluency for Business Advanced ASL Advanced Craft Brewing Advanced Energy Advanced Tax Practice Advertising & Public Relations Allied Health Sciences Anthropology Applied Anthropology Applied Behavior Analysis Applied Computer Science Applied Computing Foundations Applied Data Analytics Applied Food & Nutrition Applied GIS in Natrl Resources Applied Linguistics Applied Statistics Art and Design Art Education Art History Artificial Intel Foundations Artificial Intelligence Athletic Training Audiology Behavioral Neuroscience Behavioral Science Biochemistry Bioinformatics and Genomics Biology Biomedical Communication Biomedical Engineering Biomedical Informatics Biomedical Sciences Biopsychology Biostatistics Biotechnology Broadcasting Business Analytics Business and Taxation Business Economics Business Fundamentals Business General Business Leadership Cannabis Operations Cannabis Operations & Com Planning Cardiovascular Sonography Cell & Molecular Biology Chemistry Chinese Studies Civic Change Agent Classical Tradition Classics Classroom Technology Climate Science Clinical Dietetics Clinical Lab Science Clinical Research Trials Management Communication & Media Studies Communication Science & Disorders Communication Studies Communications Computer Science & Arts for Teaching Computer Engineering Computer Information Systems Computer Science Computing Fundamentals Corporate Transactions Criminal Justice Cybersecurity Dance Data Analytics Data Mining Fundamentals Data Science and Analytics Database Fundamentals Database Management Degree Seeking Undergraduate Diagnostic Medical Sonography Digital Forensics Fundamentals Digital Media Distributed Computing E-Commerce Earth Science Ecological Restoration Economics Education Education Birth-Kindergarten Educational Leadership Educational Studies Educational Technology Integration Educational Technology Electrical Engineering Electromagnetic Compatibility Elementary Continuing Elementary Professional Elementary Provisional Embedded Systems Emerging Business Leadership Engineering Engineering Graphical Communication Engineering Science English English as a Second Language English Language & Writing English Language and Literature English Secondary Education Entrepreneurship Environ and Sustain Studies Environmental Remote Sensing Environmental Science Environment Steward/Community Engagement ERP for Business Majors ERP for Non-Business Majors Event Sustainability Event Sustainability Ops Exercise Science Exploratory Study Facilities Management Family Nurse Practitioner Film and Video Finance Fisheries and Aquatic Sciences Fnd Intcu Fluency for Business Food & Beverage Service Foundational ASL Foundations of Tax Practice French French PK-12 Education General Education General Management Geographic Info Science Technology Geographic Info Systems Technology Geography Geology Geology-Chemistry German German PK-12 Education Gerontological Nurse Practitioner Global Studies & Social Impact Graduate Tax Studies Greek Green Chemistry Group Science Group Science Geology Group Social Science Geography Group Social Sciences Group Social Studies Group Science Biology Group Science Chemistry Group Science Math Group Social Sciences Economics Group Social Sciences History Group Social Sciences Political Science Group Social Sciences Psychology Group Social Sciences Sociology Health & Physical Education Health Administration Health and Bioinformatics Health Communication Health Information Management Health Professions Health Science Higher Education & Student Affairs Higher Education History Homebrewing Beer Honors College Hospitality Tourism Management Human Centered Computing Human Resources Human Resources Management Humanities Industrial Technology Info Security Fundamentals Info Systems Proj Management Info Visualization Fundamental Information Systems Information Systems Management Information Technology Inquiry Teaching in Chemistry Inquiry Teaching in Science Instruction & Curriculum Int Intcu Fluency for Business Integrated Science Integrated Science Elementary Integrated Science Secondary Integrative Studies Intercultural Communication Intercultural Competence Intercultural Competence Experience Intercultural Training Interdisciplinary Entrepreneurship Interdisciplinary Engineering International Business International Relations International Teaching Experience Interprof Coll Practice Gradua Interprof Coll Practice Underg Interprof Health Informatics Introduction to Mechatronics Journalism Jrnlsm, Brdcast & Digtl Media Language Arts Language Arts Elementary Language Arts Secondary Latin Latino/a Studies Leadership Leadership & Business Fund Learning, Design, & Technology Legal Studies Liberal Education & Professional Skills Liberal Studies Literacy Coaching Literacy Studies Management Manufacturing Engineering Control/Automatic Manufacturing Engineering Design Marketing Mathematics Mathematics Secondary Education Mechanical Engineering Mechanical Engineering Design Medical & Bioinformatics Medical & Health Humanities Medical Dosimetry Medical Imaging/Radiation Science Medical Laboratory Science Medical Technology Microbiology Mobile App Fundamentals Multilingualism Multimedia Journalism Music Music Education Natural Resources & Envmt Management Natural Resources Management Networking Fundamentals Non Degree Graduate Non Degree Undergraduate Nonprofit Leadership Nursing Nursing Administration Nursing Case Management Nursing/Business Object-Oriented Program Fund Object-Oriented Technology Occupational Safety/Health Management Occupational Therapy Online/Blended Instruction & Assess Operations Management Operations Research Palliative & Hospice Care I Palliative & Hospice Care II Palliative and Hospice Care Paralegal Studies Ped Cont Know 3rd-6th Ped Cont Know PreK-3rd Ped Cont Know PreK-6th Pediatric Nurse Practitioner Performing Arts Industry Philanthropy & Nonprofit Leadership Philosophy Photography Physical Education Physical Therapy Physician Assistant Studies Physics Piano Pedagogy Political Science Pre-Business Pre-Clinical Lab Science Pre-Computer Science Pre-Economics Pre-Engineering Pre-Grad Health Professions Pre-Health Pre-Health Science Pre-Information Systems Pre-Liberal Studies Pre-Medical Image/Radiation Science Pre-Medical Lab Science Pre-Nursing Pre-Physical Therapy Pre-Professional Preparation Product Design & Manufacturing Engineering Production Engineering Operations Professional Engineering Practice Professional Innovation Project Management Psychiatric Mental Health NP Psychology Public Administration Public and Nonprofit Administration Public Health Public History R Programming Radiation Therapy Radiologic & Imaging Sciences Reading Real Estate Recreational Therapy Religious Studies Respiratory Care Russian Studies Sales Fundamentals School Counseling School Psychology Science Secondary Education Secondary Continuing Secondary Professional Secondary Provisional Social Innovation Social Media & Analytics Social Work Sociology Software Design & Development Software Engineering Spanish Spanish for Health Care Professional Spanish PK-12 Education Special Education Speech-Language Pathology Sport Coaching Sport Management Standard Teaching Certificate Statistics Studio Art Supply Chain Management Sustainability Sustainable City & Regional Planning Sustainable Food Systems Sustainable Urban & Regional Planning Taxation Teacher Leader Technical Sales Technology Management Technology Project Management Telehealth Theatre Therapeutic Recreation Undeclared Victim Advocacy & Services Water Resource Policy Wealth Planning Web & Mobile Computing Web Application Fundamentals Web Design & Development Wildlife Biology Women and Gender Studies Women's Health Nurse Practitioner Women, Gender & Sexuality Study Workplace Technology & Communication Writing

Second Major
- Select Major Accounting Acute Care Ped Nurse Prac Administration Administrator-Business Manager Administrator-Central Office Administrator-Elementary & Secondary Administrator-Elementary Principal Administrator-Secondary Principal Administrator-Superintendent Adult Nurse Practitioner Adv Intcu Fluency for Business Advanced ASL Advanced Craft Brewing Advanced Energy Advanced Tax Practice Advertising & Public Relations Allied Health Sciences Anthropology Applied Anthropology Applied Behavior Analysis Applied Computer Science Applied Computing Foundations Applied Data Analytics Applied Food & Nutrition Applied GIS in Natrl Resources Applied Linguistics Applied Statistics Art and Design Art Education Art History Artificial Intel Foundations Artificial Intelligence Athletic Training Audiology Behavioral Neuroscience Behavioral Science Biochemistry Bioinformatics and Genomics Biology Biomedical Communication Biomedical Engineering Biomedical Informatics Biomedical Sciences Biopsychology Biostatistics Biotechnology Broadcasting Business Analytics Business and Taxation Business Economics Business Fundamentals Business General Business Leadership Cannabis Operations Cannabis Operations & Com Planning Cardiovascular Sonography Cell & Molecular Biology Chemistry Chinese Studies Civic Change Agent Classical Tradition Classics Classroom Technology Climate Science Clinical Dietetics Clinical Lab Science Clinical Research Trials Management Communication & Media Studies Communication Science & Disorders Communication Studies Communications Computer Science & Arts for Teaching Computer Engineering Computer Information Systems Computer Science Computing Fundamentals Corporate Transactions Criminal Justice Cybersecurity Dance Data Analytics Data Mining Fundamentals Data Science and Analytics Database Fundamentals Database Management Degree Seeking Undergraduate Diagnostic Medical Sonography Digital Forensics Fundamentals Digital Media Distributed Computing E-Commerce Earth Science Ecological Restoration Economics Education Education Birth-Kindergarten Educational Leadership Educational Studies Educational Technology Integration Educational Technology Electrical Engineering Electromagnetic Compatibility Elementary Continuing Elementary Professional Elementary Provisional Embedded Systems Emerging Business Leadership Engineering Engineering Graphical Communication Engineering Science English English as a Second Language English Language & Writing English Language and Literature English Secondary Education Entrepreneurship Environ and Sustain Studies Environmental Remote Sensing Environmental Science Environment Steward/Community Engagement ERP for Business Majors ERP for Non-Business Majors Event Sustainability Event Sustainability Ops Exercise Science Exploratory Study Facilities Management Family Nurse Practitioner Film and Video Finance Fisheries and Aquatic Sciences Fnd Intcu Fluency for Business Food & Beverage Service Foundational ASL Foundations of Tax Practice French French PK-12 Education General Education General Management Geographic Info Science Technology Geographic Info Systems Technology Geography Geology Geology-Chemistry German German PK-12 Education Gerontological Nurse Practitioner Global Studies & Social Impact Graduate Tax Studies Greek Green Chemistry Group Science Group Science Geology Group Social Science Geography Group Social Sciences Group Social Studies Group Science Biology Group Science Chemistry Group Science Math Group Social Sciences Economics Group Social Sciences History Group Social Sciences Political Science Group Social Sciences Psychology Group Social Sciences Sociology Health & Physical Education Health Administration Health and Bioinformatics Health Communication Health Information Management Health Professions Health Science Higher Education & Student Affairs Higher Education History Homebrewing Beer Honors College Hospitality Tourism Management Human Centered Computing Human Resources Human Resources Management Humanities Industrial Technology Info Security Fundamentals Info Systems Proj Management Info Visualization Fundamental Information Systems Information Systems Management Information Technology Inquiry Teaching in Chemistry Inquiry Teaching in Science Instruction & Curriculum Int Intcu Fluency for Business Integrated Science Integrated Science Elementary Integrated Science Secondary Integrative Studies Intercultural Communication Intercultural Competence Intercultural Competence Experience Intercultural Training Interdisciplinary Entrepreneurship Interdisciplinary Engineering International Business International Relations International Teaching Experience Interprof Coll Practice Gradua Interprof Coll Practice Underg Interprof Health Informatics Introduction to Mechatronics Journalism Jrnlsm, Brdcast & Digtl Media Language Arts Language Arts Elementary Language Arts Secondary Latin Latino/a Studies Leadership Leadership & Business Fund Learning, Design, & Technology Legal Studies Liberal Education & Professional Skills Liberal Studies Literacy Coaching Literacy Studies Management Manufacturing Engineering Control/Automatic Manufacturing Engineering Design Marketing Mathematics Mathematics Secondary Education Mechanical Engineering Mechanical Engineering Design Medical & Bioinformatics Medical & Health Humanities Medical Dosimetry Medical Imaging/Radiation Science Medical Laboratory Science Medical Technology Microbiology Mobile App Fundamentals Multilingualism Multimedia Journalism Music Music Education Natural Resources & Envmt Management Natural Resources Management Networking Fundamentals Non Degree Graduate Non Degree Undergraduate Nonprofit Leadership Nursing Nursing Administration Nursing Case Management Nursing/Business Object-Oriented Program Fund Object-Oriented Technology Occupational Safety/Health Management Occupational Therapy Online/Blended Instruction & Assess Operations Management Operations Research Palliative & Hospice Care I Palliative & Hospice Care II Palliative and Hospice Care Paralegal Studies Ped Cont Know 3rd-6th Ped Cont Know PreK-3rd Ped Cont Know PreK-6th Pediatric Nurse Practitioner Performing Arts Industry Philanthropy & Nonprofit Leadership Philosophy Photography Physical Education Physical Therapy Physician Assistant Studies Physics Piano Pedagogy Political Science Pre-Business Pre-Clinical Lab Science Pre-Computer Science Pre-Economics Pre-Engineering Pre-Grad Health Professions Pre-Health Pre-Health Science Pre-Information Systems Pre-Liberal Studies Pre-Medical Image/Radiation Science Pre-Medical Lab Science Pre-Nursing Pre-Physical Therapy Pre-Professional Preparation Product Design & Manufacturing Engineering Production Engineering Operations Professional Engineering Practice Professional Innovation Project Management Psychiatric Mental Health NP Psychology Public Administration Public and Nonprofit Administration Public Health Public History R Programming Radiation Therapy Radiologic & Imaging Sciences Reading Real Estate Recreational Therapy Religious Studies Respiratory Care Russian Studies Sales Fundamentals School Counseling School Psychology Science Secondary Education Secondary Continuing Secondary Professional Secondary Provisional Social Innovation Social Media & Analytics Social Work Sociology Software Design & Development Software Engineering Spanish Spanish for Health Care Professional Spanish PK-12 Education Special Education Speech-Language Pathology Sport Coaching Sport Management Standard Teaching Certificate Statistics Studio Art Supply Chain Management Sustainability Sustainable City & Regional Planning Sustainable Food Systems Sustainable Urban & Regional Planning Taxation Teacher Leader Technical Sales Technology Management Technology Project Management Telehealth Theatre Therapeutic Recreation Undeclared Victim Advocacy & Services Water Resource Policy Wealth Planning Web & Mobile Computing Web Application Fundamentals Web Design & Development Wildlife Biology Women and Gender Studies Women's Health Nurse Practitioner Women, Gender & Sexuality Study Workplace Technology & Communication Writing

Minor
- Select Major Accounting Adventure Tourism Advertising & Public Relations African/African-American Studies Africana Studies Aging and Adult Life Anthropology Applied Communication Applied Linguistics Applied Linguistics - Teaching Applied Music Choral Applied Music Instrumental Applied Statistics Aquatic Sciences Arabic Archaeology Art and Design Art Education Art History Artificial Intelligence Biology Biology -Teaching Biomedical Engineering Business General Cannabis Operations Management Cell & Molecular Biology Chemistry Chemistry - Teaching Chinese Language City and Regional Planning Classical Tradition Classics Classics-Classical Tradition Classics-Greek Classics-Latin Classics-Latin, Secondary Education Climate Science Communication & Public Advocacy Computer Engineering Computer Science Computer Science - Teaching Computing and Philosophy Criminal Justice Cybersecurity Dance Data Science Digital Studies Disability Studies Early Childhood Education - Teaching Early Childhood Education Earth Science Earth Science - Teaching East Asian Studies Economics Economics - Teaching Elementary Distributed-Psychology Special Education Elementary Certification Elementary Distributed Engineering Science English English - Teaching Entrepreneurship Environ and Sustain Studies Environmental Science Environmental Studies Ethics, Culture and Society Event Sustainability Management Film and Video Film and Video Production French French - Teaching French PK-12 Teaching Geographic Techniques Geography-Teaching Geography-Technical Geology Geospatial Technology German German - Teaching German PK-12 Teaching Greek Group Social Science Geography Health Care Ethics Healthcare Information Systems History History - Teaching History of Science Honors Economics Hospitality Tourism Management Human Centered Computing Human Rights Information Security Systems Information Systems Information Technology International Business International Relations Japanese Juvenile Justice Latin Latin American & Latino/a Studies Latin American Studies Legal Administration Legal Studies LGBTQ Management Marketing Math Elementary Teaching Math Secondary Teaching Mathematical Statistics Mathematics MathTeachingMinor:5-9 MathTeachingMinor:7-12 Microcomputer Applications Microcomputer Systems Middle East Studies Movement Science Music Music - Teaching Natural Resources & Envmt Management Natural Resources Management Nonprofit Administration Occupational Safety/Health Management Philosophy Photography Physical Education Physical Education - Teaching Physics Physics - Teaching Political Science Political Science - Teaching Psychology Psychology - Teaching Psychology-Social Work Public Administration Religious Studies Russian Russian Studies School Health Education Sociology Sociology - Teaching Software Engineering Spanish Spanish - Teaching - Elementary Spanish - Teaching - Secondary Spanish PK-12 Teaching Statistics STEM Ethics Studio Art Sustainable Urban & Regional Planning Theatre Urban and Regional Planning Women and Gender Studies Women, Gender & Sexuality Study Writing Writing Business and Professional

Academic Standing *
- Select Option 1st year 2nd year 3rd year 4th + year Graduate Student

Anticipated Graduation Semester/Year *

Are you a first generation student?
- Select Option Yes No

Have you served in the military?
- Select Option Yes No

Are you an NCAA Athlete?
- Select Option Yes No

Do you live on campus?
- Select Option Yes No

Please describe your involvement on campus outside of course work (i.e. student organizations, jobs)

Please specify any necessary accommodations.

What is your race and/or ethnicity?
Select all that apply.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White

How did you hear about this program? (Please check all that apply)
Flyer
Word of Mouth
Lanthorn Article
Social Media
Department Website
Email
Classroom/Faculty
Resident Assistant
Information Table
Not listed Please specify a value for How did you hear about this program? (Please check all that apply)

Thank you for your interest in becoming a Mental Health Ambassador!  We are excited to offer an interactive training to provide you with the tools and resources necessary to enhance mental health on campus.

Our session will take place on Friday, January 30 from 10:00 a.m. - 4:00 p.m. in the Kirkhof Center Room 2270. 

Please type your name below as an indication that you are available and willing to participate in the full duration of this training.

Name *

Photos may be taken during the training for use on the University Counseling Center's website and social media platforms. Please type your name to indicate your acknowledgement of this below. *

Our program will include a complimentary lunch. Please list any dietary restrictions.