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PPP Awareness Day - Community Mosaic Submission Application
Contact Information
Name
*
First Name
Last Name
Email
*
The email address you provide will be used by the PPP Awareness Day Storytelling team to stay in touch with you. Please DO NOT provide an email address where you are NOT comfortable with receiving messages about this submission / perinatal psychosis storytelling.
Verify Email
*
Phone
Address (so we can send you snail mail!)
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Additional Submission Details
Please choose the option that best fits your perspective within the PPP community:
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**These submissions will be included at the discretion of the PPP Awareness Day Storytelling team. They should *not* tell a survivor's story for them; rather, they must be centered on the lived experience of the ally/advocate who creates the submission.
I experienced psychosis during the perinatal period (pregnancy, birth, after loss, or postpartum).
My loved one experienced psychosis during the perinatal period.
I lost a loved one due to psychosis during the perinatal period.
**I have cared for or advocated on behalf of someone who has experienced perinatal psychosis (or their loved ones).
Briefly describe the type of submission you’d like to make to the Community Mosaic project:
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Will you submit an essay, written reflection, creative writing, poetry, images / art, short video, multimedia project, etc?
Do you have concerns about privacy / using your real name with your submission?
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Yes
No
What name should we use to post your submission?
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Options include: first + last name, or first name + last initial, or first + last initials. You can use a pseudonym if desired.
If you would like us to tag you on Facebook, please provide your @handle or profile URL.
If you would like us to tag you on Instagram, please provide your @handle or profile URL.
Acknowledgements
Acknowledgement of Submission Approval Process
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The PPP Awareness Day team will work with you to revise and finalize your submission, including removal of any stigmatizing language, adding trigger warnings as needed, applying topic tags, etc. Answer “yes” if you are OK with a PPPAD team member making these updates, with your assistance. Your submission will only be published with your final approval and after you complete a release for public sharing.
Yes
I acknowledge that my intent is to share this material to be published on the PPP Awareness Day website, as part of the Community Mosaic project.
*
Yes
I acknowledge that social media posts will be created from my submission, and posted to the PPP Awareness Day social media channels with links to where my submission is published on the PPPAD website.
*
Yes
Submission
I will email my submission to the PPPAD team at the address below.
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storytelling@pppawarenessday.org
Yes
No
If you have a link where the PPP Awareness Day team can access your submission, please share it here:
(Google Drive, DropBox, etc)