Request for Support Services

Swing Fore Cesar Golf Tournament & Law Enforcement Mental Health Awareness

We’re here to support individuals and organizations in the law enforcement community with mental health and well-being services. Please complete the applicable section below to tell us how we can help.

If you are a Law Enforcement Officer and looking for assistance for you or a family member, you can also reach out to The Butte Strong Wellness Manager, Jodi Drysdale at (530) 321-8429.

If you are in a crisis situation, please contact Butte County Department of Behavioral Health at (530)891-2810, call 911, or go to the nearest emergency room. We will make every effort to respond to your application within 24-48 hours.

Name

First Name

Last Name

Phone

(###)

###

####

Preferred Contact Method

Phone

Text

Any

How can we support you?

Please check all the services you're interested in.

Mental Health Services

Counseling

Peer Support

General Support

Other

Your Story:

We’d like to hear about your current needs and how these services can make a difference in your life:

Your Goals:

What outcomes do you hope to achieve through these services?

We’re here for you.

Personal Request for Services

Organizational Request

We’re here for you.

Organization Name:

Contact Person:

First Name

Last Name

Role / Title:

Phone

(###)

###

####

Website (if applicable):

How can we support your Organization?

Please check all the services your organization is interested in:

Mental Health Services

Counseling

Peer Support

General Support

Other

About Your Organization:

Tell us about your mission, the people you serve, and how these services could make an impact:

Implementation and Goals:

How do you plan to use these services, and what outcomes do you hope to achieve for your team?

Additional Information:

Is there anything else you’d like us to know? Special considerations, previous experiences, or any additional context:

Acknowledgment:

By signing below, you confirm that the information provided is accurate and that the requested services will be used to support mental health and well-being efforts for our law enforcement community.

Name

First Name

Last Name

Date

YYYY

Have questions?

Request for Support Services

Swing Fore Cesar Golf Tournament & Law Enforcement Mental Health Awareness

We’re here for you.

Personal Request for Services

Organizational Request

Thank you for your commitment to mental health awareness. We’re here to support you every step of the way!