25/26 tMHFA Pre-Participation Survey

Teen Mental Health First Aid Pre-Participation Survey

2025-2026 School Year
Name*

First NameLast Name
Email*
example@example.com
Student ID:*
School (please note - only students attending a public MCPS high school are eligible at this time):*
Please Specify*
Date of Birth*

MonthDayYear
Date
Grade*
Please provide the best contact number to reach you:
Please enter a valid phone number.Format: (000) 000-0000.
Is this a number we can text to confirm attendance?

YesNo
Have you previously participated in a Teen Mental Health First Aid Training?

YesNo
Do you belong to your school’s Our Minds Matter Club?

YesNo
Have you attended an Our Minds Matter Club Meeting at your school this school year?

YesNo
Have you participated in ANY Our Minds Matter Club-Sponsored Events at your school this year?

YesNo
Were you referred by someone who recently completed a tMHFA training?*

YesNo
If yes, please provide their name:*

First NameLast Name
If yes, please provide their email:*
example@example.com
The following trainings are currently offered. Please select a training below, noting the dates, times, and locations. Some trainings will be held at your school, while others may be held at JSSA's office location (200 Wood Hill Road, Rockville, MD) or another community-based location. BE SURE TO SELECT ONLY ONE TRAINNG SESSION.

In order to receive the $ 100.00 stipend, YOU MUST ATTEND ALL SCHEDULED SESSIONS and complete the post-participation survey form.
Which location would you like to sign up for? (If choosing a school based option, must sign up for the school you attend)*

JSSA Fallsgrove OfficeWootton High School (Must attend Wootton to participate)Thomas Edison High School of Technology (Must attend Thomas Edison to participate)
Trainings Offered at Paint Branch HS*

Dates: 4/27, 5/4, 5/11; Time: 2:35-4:35pm; Room: The Paw
Trainings Offered at JSSA Fallsgrove Office*

Dates: 5/11, 5/13, 5/15 Time: 5PM-6:30PM
Trainings Offered at Walter Johnson HS*

4/14, 4/21, 4/28; Time: 2:45-4:15pm in Room 148
Trainings Offered at Thomas Edison HS*

5/15, 5/18, 5/20; Time: 8:30-10:00am; Room: Contact Carey Ostry5/15, 5/18, 5/20; Time: 11:35am-1:05pm; Room: Contact Carey Ostry
Trainings Offered at Wootton HS*

5/28, 6/4, 6/11; Time: 2:45-4:15pm in College and Career Counseling Room
Trainings Offered at R.A.P. Program*

Dates: 3/9, 3/11, 3/13, 3/16, 3/18, 3/19; Time: 12:30-1:15PM (RAP Students ONLY)
Trainings Offered at Walter Johnson High*

Dates: 2/3, 2/10, 2/24; Time: 2:45-4:15pm in Room G-02
Trainings Offered at Wootton HS*

Dates: 2/19, 2/26, 3/5; Time: 2:45-4:15pm; Room: College and Career Counseling Center/Room
What session would you like to sign up for? Both sessions will be held at JSSA Fallsgrove Office 200 Wood Hill Rd, Rockville, MD 20850 3rd Floor Conference Room*

12/29, 12/31 and 1/2 9:30-11:00AM12/29, 12/31 and 1/2 1-2:30PM
ALL SESSIONS ARE CURRENTLY FULL! PLEASE CHECK BACK AGAIN SOON!
Trainings Offered at Kennedy High School*

9/29, 10/1, 3, 6, 8, 10 Room 3301 2:45-3:30
What location would you like to sign up for?*

All sessions are currently full, please check back soon
Trainings Offered at Bethesda Chevy Chase High School*

10/21, 10/28, 11/4, 11/11, 11/18, 11/25; Room: F310; Time: 11:15AM-12:00PM
Trainings Offered at Walter Johnson High School*

11/4, 11/11, 11/18; Room GO2; Time: 2:45-4:15PM
Trainings Offered at Northwood High School

11/11, 11/18, 11/20 2:30-4:00 in Room 2108
Please rate your agreement with the following statements:
I am comfortable talking with my friends about concerns related to their mental health.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I am comfortable talking with my parents about concerns related to my mental health.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I have at least one trusted adult (non-family member) who I can speak with about concerns related to my mental health.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I feel confident in my ability to identify, understand, and respond if my friend shows warning signs of suicide.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
I feel confident in my ability to identify, understand, and respond if my friend shows warning signs of a non-suicide-related crisis.

1

2

3

4

5

1 is Strongly Disagree, 5 is Strongly Agree
Should be Empty:

Teen Mental Health First Aid Pre-Participation Survey

Please rate your agreement with the following statements: