Campus Advocate Sign-Up form

Personal Email *

School Email *

First Name *

Last Name *

Pronouns

Birthdate *

Phone Number * 1234567898

Preferred Mailing Address Line One *

Preferred Mailing Address Line Two

City *

State *

Zip *

Are you a Crisis Text Line Volunteer Crisis Counselor? *

University/College Name * Please enter the full name of your university and campus like "University of Georgia—Athens"

Level of Study *

Level of Study Write-in *

Major/Field of Study *

Expected College Graduation Date *

Language fluency * EnglishSpanishAnother Language Please select all that apply.

Language fluency Write-In

Race. How do you identify? * Native American, Native Alaskan or IndigenousAsian, Asian American (Including all regions of Asia)Black or African AmericanLatino / Latina / Latinx / Latine or HispanicMiddle Eastern, North African, or ArabNative Hawaiian or Pacific IslanderWhitePrefer not to answerOther—Write in how you identify Please select all that apply.

Other—Write in how you identify

Gender: How do you identify? * MaleFemaleNon-BinaryPrefer Not To SayAgenderBoy/ManGenderfluidGenderqueerGirl/WomanIntersexTransTrans MasculineTrans FeminineTwoSpiritOther - Write in how you identifyPrefer not to answer Please select all that apply.

Other - Write in how you identify

Sexual Identity. How do you identify? * Asexual (Ace)Aromantic (Aro)BisexualGayLesbianPansexualQueerQuestioningStraight or HeterosexualNot surePrefer not to answerOther - Write in how you identify Please select all that apply.

Other - Write in how you identify

Have you ever served in the US military? *

Do you have a disability or condition that may require accommodation? * Prefer not to answerNoNot sureDeafnessHard of HearingBlindnessVisually ImpairedDyslexiaADD/ADHDOther - Write InAutismMobility Difficulties

Disability or Condition Write-in

Are you registered to vote in the US? * This information will be helpful for us if you'd ever like to participate in Public Policy and Advocacy actions.

What state are you registered to vote in? *

How did you hear about us? * Please tell us a little bit about how you learned about our organization and our Campus Advocates program.

Please add the Individual or Organizations name: *

I Agree to Crisis Text Line storing and using my information for record-keeping, research, contacting me, evaluating and improving its services, marketing and recruiting efforts.

I Agree to abide by Crisis Text Line policies, including its Volunteer Terms of Service & Privacy Policy and Code of Conduct.

Campus Advocate Sign-Up Form

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