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For Salesforce
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Use the Default Value field under "Options" to enter the value for all participants

Program or Project (enter the program or project the form is associated with)

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Form Name (enter the exact form name in Form Assembly)

Levels of Addiction: Uncovering Tools for Prevention Webinar

Wednesday, May 13th from 5:30-7pm

Virtual- Zoom

Join GCAPP’s Youth Advisory Council (YAC) members for a powerful, youth-led conversation on how illegal substance use is impacting young people across Georgia. This initiative, led by youth from Newton, Fulton, and Pierce counties, centers real experiences from schools and communities.

Your responses are confidential and will be kept private to the fullest extent allowed by law. Any personal information you provide, including your name and email address, will be securely stored and used only by GCAPP for purposes related to this survey and follow-up communication. Individual responses will not be shared publicly.

By providing your contact information, you consent to GCAPP contacting you with information about programs, resources, events, and awareness initiatives related to our mission. Your information, including your email address, may also be used to support outreach and engagement efforts, such as connecting with you on social media. You may opt out of these communications at any time.

Participant Information

First Name

Last Name

Email

Phone

What organization or school do you represent?

What sector do you work in?

County of Residence

Zip/Postal Code

Year

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Demographics

Race / Ethnicity

Gender

Personal Pronoun

Sexual Orientation

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Connect with us on Social Media

If you would like to share, please provide your social media handle(s). This information is optional and will only be used to connect with you about relevant content, programs, or community engagement opportunities.

Facebook	Instagram
TikTok

Follow GCAPP on Social Media

We invite you to follow or like GCAPP on social media to stay connected and receive updates, resources, and upcoming opportunities.

Every follow, like, or share helps extend our reach and strengthens our efforts to support and promote health for young people in Georgia.
GCAPP on TikTok

Click the links below to follow us.

GCAPP on Facebook
GCAPP on Instagram
GCAPP on TikTok

Teacher	Student	Parent/Caregiver	Volunteer
Young Adult (18-24)	Youth (10-17)	Youth-Serving Professional