MENTAL HEALTH CHAMPION REGISTRATION FORM

THE MENTAL HEALTH COMMUNITY REGISTRATION FORM

A mental health champion is someone who takes action to raise awareness of mental health and challenge stigma.

We are looking for psychologists who…

Are deeply invested in empowering people to work towards better mental health Have the expertise to work with a wide range of populations and clinical concerns Want to build new skills sharpen their expertise, and nurture their professional journey Are looking to grow by working alongside other committed & experienced clinical experts

* Name

* Designation

* Email

* Contact number

Country

State

City

*Upload Photo Please Upload only JPG/PNG and size less than 2MB

*Do you have a mental health counsellor license Yes

*License Number

*License Provided by (Name of institute)

Hobbies and Interests

*Age

*Date of Birth

*Years of Experience

Educational Qualification (In chronological order)

*Brief Profile