Thank you for your interest in participating in the Give an Hour program. Give an Hour is a national nonprofit organization with a large network of mental health professionals who offer no-fee mental health counseling to those in need. Everytown for Gun Safety has partnered with Give an Hour on a pilot project to provide Everytown and Moms Demand Action survivor leaders and their families 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 confidential 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, however your feedback and satisfaction with this pilot will help direct us in how we continue with Give an Hour after this pilot concludes. 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 any information collected or services provided through the Give an Hour program partnership.
Once you complete this form, you will be given the link to the Give an Hour/Everytown partnership page, where you will fill out the information necessary to be contacted by a Give an Hour referral specialist who will work with you to find a suitable mental health provider.
Thank you for your participation.
— The Survivor Team