Active Minds Mental Health Institute Referral Form

Thank you for supporting a student in their application to Active Minds’ Mental Health Advocacy Institute. We value your insight into their character, leadership abilities, and reliability for this opportunity. Please complete the following form to provide your recommendation no later than October 6th, 2024.

Recommender's Information

First Name

Last Name

Position/Title

Department

Institution (No abbreviations please)

Student Name

Student Email

How long have you known the student, and in what capacity?

Please confirm that to the best of your knowledge, the person above is a current student at your institution.

To the best of your knowledge, does the student have leadership experience or demonstrate leadership potential in their academic or extracurricular activities?

Please describe their leadership roles

Are you aware of any concerns or issues that may affect the student's ability to successfully participate in the Mental Health Advocacy Institute, such as difficulties with professionalism, teamwork, or communication?

If "yes" please briefly explain

Please share any additional thoughts or information that may support this student's application

Contact Information