We Are Active Minds Middle School Curriculum Form
Purpose:
Online interest form for middle schools to fill out if interested in implementing the We Are Active Minds Middle School Curriculum
School/organization name (no abbreviations)
Type of school or organization
Please select...
Middle School
After school program
Non-profit organization
Name of
district
your
school/organization is located in
Name of
state
your school/organization is located in
Please select...
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other (Outside U.S.)
Other State:
Will you be the person implementing the curriculum with students?
Please select...
Yes
No
Unsure
First name of staff person implementing curriculum
Last Name of staff person implementing curriculum
School/organization email address of staff person implementing curriculum
Role of staff person implementing curriculum in your school/organization
Please select...
Teacher
Administrator
School counselor, psychologist, social worker, or other mental health professional
Other (please specify)
Other Role: Please Specify
Your First name
Your Last Name
Please provide your school/organization email address
Please share your role in your school/organization
Please select...
Teacher
Administrator
School counselor, psychologist, social worker, or other mental health professional
Other (please specify)
Other Role: Please Specify
Does your school or organization serve an under-resourced community? Active Minds defines under-resourced as a school that might be Title I, in a rural area, inner city or urban area, and more.
Please select...
Yes
No
Have you implemented the We Are Active Minds Middle School Curriculum before?
Yes
No
Where do you plan to implement the We Are Active Minds Middle School Curriculum? (please select all that apply)
P.E. or health class
Study hall, free period, or advisory period
During another class period
During a We Are Active Minds Middle School Club meeting
During a club period that is NOT We Are Active Minds Middle School Club
In a non-profit space or separate from a school
After school programming
Other
You selected during a club period other than We Are Active Minds Middle School Club or Other. Which setting best describes where you plan to implement the curriculum?
What grades do you plan to implement We Are Active Minds Middle School with? (please select all that apply)
6th grade
7th grade
8th grade
Will you be implementing it with an entire grade level or specific students?
Yes, I’ll be implementing with entire grade levels.
No, I’ll be implementing with specific students.
Please share more about the specific student group you will implement the curriculum with.
We are thrilled to share our new 8th grade leadership program, which helps 8th grade students who experienced We Are Active Minds Middle School Curriculum continue the conversation on mental health with their peers. Would you be interested in hearing more about this opportunity for your students?
Yes
No
How many students do you plan to implement with?
Please provide the estimated date you plan to begin to implement the curriculum.
We are here to offer support, resources, and community. How much support or contact would you like to receive from our Youth Leadership Team?
Yes, reach out! I would love to learn more about Active Minds, share ideas, find paths to support my students, and build community!
No, thank you. I am good to receive the curriculum with minimal contact from the Youth Leadership Team.
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