Inquiry - Programs for Emotional & Behavioral Wellbeing

If you would like to be contacted about a JCS Prevention Education program that can meet your school or organization's needs, please complete this form. One of our Health Educators will contact on the next business day.

Your Name Your Name First Last
School or Organization You Represent, if applicable
Your Role at School/Organization
Your Email
Your Phone # Your Phone # - ### - ### ####
Please tell us the age range(s) of the participants for whom you are seeking programming.

Please tell us the age range(s) of the participants for whom you are seeking programming. Pre-school Elementary school Middle school High School College Adults Older Adults
Areas of Interest

Areas of Interest Substance Use / Addiction Prevention Mental Health & Wellness Bullying Self-Esteem / Body Image Social Media Safety Vaping Grief Building Resilience Wellness My Way Other Other
Please feel free to share additional information regarding your programming needs.
If you wish to receive our Program Catalog by mail, please complete the following: If you wish to receive our Program Catalog by mail, please complete the following:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country