Signature Campaign Box Request
School Name
First Name
Last Name
Email
Phone Number
Is there currently an OMM club/program at your school?
Yes
No
No, but interested in starting!
Club Role
Please select...
Student Leader
Club Sponsor
OMM Staff
Other
Role at School
Please select...
Student
Educator/School Staff
Mental Health Professional
Other
For OMM Staff: How should this box be sent?
Shipped
Brought in person
I want to host and receive supplies for...
Because You Matter
When do you plan to host this campaign
Boxes are mailed weekly on Wednesday
Would you like to schedule a 15-minute video call to get planning support from OMM?
Yes
No
Do you need the campaign assets translated into Spanish?
Yes
No
Any other questions for us?