Please complete this interest form and we will share it with your school counselor or social worker. Your counselor or social worker will then talk to you about if Daybreak is right for you!

If you are experiencing a mental health crisis, reach out to your school counselor immediately or dial 988 to reach the Suicide and Crisis Lifeline.

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* 1. Student First and Last Name

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* 2. Student Email Address

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* 3. Student Phone Number

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* 4. Which teletherapy program are you interested in?

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* 5. How did you hear about Daybreak?

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