Thank you for your interest in sharing your story on our podcast! Our podcast gives teens a safe, supportive space to talk honestly about mental health. Please answer the questions below to help us understand your journey, your comfort level, and whether this is the right fit for you. Your answers are confidential and help us make sure every guest is ready, comfortable, and supported. If you have any questions, please reach out to us at [email protected]. Full Name* First Name Last Name Phone Number* E-mail I am:* 13 years old14 years old15 years old16 years old17 years old18 years old19 years old20 years old and up12 years old or less City and State:* How did you learn about the podcast? Please share a summary of your mental health journey. (What happened, what you’ve learned, and why you want to share it.) Example: "I struggled with anxiety during middle school and found support through therapy and art." Your Mental Health Story:* When did your most difficult mental health challenges happen? (Approximate dates or ages - for example: "Spring 2023" or "Age 14–15") 📅 Approximate Dates of Mental Health Crisis* 💊 Have you ever seen a psychiatrist?* YesNoPrefer not to answer Have you ever seen a therapist?* Yes, in the pastYes, in presentNo What helped you on your journey? Therapy / CounselingSupportive familySupportive friendsMedicationSchool counselorFaith / Spiritual supportSports or physical activityArts (music, writing, art, etc.)Support groups Did your mental health challenges ever affect these areas? SchoolFamily relationshipsFriendshipsSleepAppetiteBehaviorSafetyMoodEnjoyment of activities 🏥 Did you ever receive a higher level of care for your mental health?* Day treatment programHospitalization (overnight or longer)Residential treatmentNone of these If yes, please share approximate dates (month/year if possible): (1 = just beginning, 5 = feel fully stable) 📈 How far do you feel you are in your mental health recovery?* 12345 Do you feel comfortable sharing your story publicly on a podcast?* Yes, fully comfortableMaybe — I’d like to talk moreNo Is there any part of your story you’d prefer not to discuss on the podcast?* By submitting this form, I understand: My answers will be reviewed by the podcast team to help decide if my story is a good fit. And if it will air or not.Sharing my story is voluntary and I can choose not to answer any question that feels uncomfortable.I can withdraw my interest at any time.If chosen, I will have a chance to talk with the team before recording and can set clear boundaries on what I do or don’t want to share.I agree and would like to be considered for an interview Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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