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Give an Hour

Thank you for your interest in participating in the Give an Hour program. Everytown for Gun Safety has partnered with Give an Hour on a pilot project to provide Everytown and Moms Demand Action survivor leaders with no fee individual counseling services.


In order to gain access to the Give an Hour program’s mental health providers/services in your area, please complete the acknowledgement and waiver form. Your name and demographic information will be kept confidentially by Everytown and used solely for the purpose of anonymous tracking of the utilization of this pilot.


Additionally, the form asks if you are willing to participate in a focus group, personal interview, or complete a survey about your satisfaction with your experience with the Give an Hour program. Participation in this follow up is not required, but we welcome your feedback. All information provided will be kept confidential.



Once you complete the acknowledgement and waiver form and enter the Give an Hour program site, HIPPA laws apply; Everytown has no access to any information collected by service providers volunteering for the Give an Hour program partnership.


Once you complete the form, you will receive an email with instructions on how to access the directory of Give an Hour providers in your area that are participating in this program.


SIGN ACKNOWLEDGEMENT AND WAIVER FORM

Thank you for your participation.


Sincerely,


— The Survivor Team


SIGN THE ACKNOWLEDGEMENT AND WAIVER FORM

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