Empowering Black Youth: Shape the Future of Mental Health Support

Parent's Full Name

Parent's Email Address

Parent's Phone Number (10-digit US)

Child's Full Name

What is your childs email address?

Child's Age (13-17)?

City and State

Is your child currently enrolled in a U.S. middle or high school?

Yes No

Does your child identify as Black or African American?

Yes No

How often does your child use social media?

At least once a week Less than once a week

On average, how many hours per day does your child use social media?

Less than 1 hour 1-2 hours More than 3 hours

Are you and your child willing to attend a virtual screening meeting where both parent and child will be present with audio and video enabled?

Yes No

Are you aware that participation involves virtual focus groups where audio and video recording is required?

Yes No