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Heart-to-Heart Support Request
Request Type
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Your Name
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Organization Name (if applicable)
Email
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Phone
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Title/Role
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Mailing Address
Street
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City
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Province/Territory
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Postal Code
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Request Details
Number of hearts requested = 50
How do you plan to distribute and use the hearts in your school/organization?
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Please describe your distribution approach and intended use. For example: Will a counselor distribute them to students in need? Will they be part of a specific mental health initiative? Are they for students experiencing chronic absenteeism? Will you be establishing a peer support team to manage distribution? The more details you can provide, the better we can understand the impact of our Heart-to-Heart campaign.
Special requests or considerations (optional)
Shipping Cost Reimbursement
Please provide payment information for the $20 Canada Post shipping fee reimbursement per 50 hearts.
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Acknowledgment
By submitting this form, I understand that:
YMHC will process my request based on availability of hearts.
Hearts are sent at no cost, except for shipping costs, as part of YMHC's mental health advocacy.
Information provided will be kept confidential and used only for processing this request.
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