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EXPERT CONTRIBUTER FORM
Full Name
Professional Title
Pronouns
Email
Email
Social Media
Organization/Practice
Phone
Location
Published Works
Website
How many years of experience
*
Required
Under 5
5-10
11-20
20+
What populations do you primarily serve?
*
Required
Black Women
Black Men
Adolescents
Young Adults
Families
Couples
Veterans
LGBTQ+
General Adult Population
Other
Areas of Specialization
*
Required
Anxiety
Depression
Trauma/PTSD
Grief
Men's Mental Health
Relationship Issues
Substance Abuse
Suicide Prevention
Idenity/Race
Child Hood Trauma
Family Systems
Emotional Wellness
Other
What topics do you feel most qualified to discuss?
*
Required
Mental Health Stigma
Black Men & Therapy
Emotional Vulnerability
Trauma
Depression
Anxiety
Masculinity
Fatherhood
Relationships
Grief
Community Healing
Faith and Mental Health
Access to Care
Emotional Resilience
Other
Do you have an office location we can film in?
Yes
No
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I acknowledge that my participation in The Fade Project is voluntary. I agree that the information, opinions, and professional insights I provide during my interview will be truthful and, to the best of my knowledge, accurate and based on my education, training, professional experience, research, or lived experience. I understand that The Fade Project is committed to presenting factual, responsible, and authentic conversations about mental health and wellness, and I agree to contribute in a manner consistent with those values.
SUMBIT
Thank you so much for your time and gifts!
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