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Thank you for your interest in CogWell's Listen Up Program! We are looking forward to connecting with you to offer support and resources for your campus.

Please fill out the following interest form so we can learn more about your school community. Your responses will not be shared, but kept internally to give us an idea about the needs of your school and how to proceed.

Thank you for working to support the students on your campus!

First Name

Last Name

Phone

University

Position *

Administrator

Staff

Faculty

Student - Senior

Student - Junior

Student - Sophomore

Student - Freshmen

Student - First Year

Other

Department (athletics, Greek life, student life, academics, etc)

How did you hear about CogWell? * Required

Social Media

Chapter Member

Friend or Colleague

Workshop Participant

Other

Area of Interest * Required

Listen Up Workshop

Starting a Chapter

Both

Other

How great is the need for mental health support on your campus? Please explain.

What mental health and peer support programs already exist on your campus?

Do you have any student-run mental health and/or peer support clubs on campus?

Thank You for Contacting Us!

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Thanks for submitting!

CogWell is a nonprofit organization that empowers college students to address mental health issues. Through their Active Listening workshops, CogWell teaches students how to provide safe spaces for peers who may be struggling with the many stressors of college life.

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Email: info@cogwell.org

Registered 501(c)(3)

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