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Response Summary: Chapters - Registration Form (2023/24) Jack.org is conducting this survey to better understand the mental health attitudes, behaviours, and advocacy confidence of the people who join our program. Your opinion matters to us and can help improve the program for future participants! Please fill out this form, which should take approximately 10 minutes to complete. Note that your personal information will only be accessed by Jack.org program staff you are directly working with. However, if you disclose something in your survey comments related to harm or abuse that makes us concerned for your safety, we have a legal obligation to report these disclosures if you are under the age of 18. Regardless of your age, we will follow up with you directly to check in about your safety. Finally, responding to survey questions with “Prefer not to say” if you do not feel comfortable answering those questions will not result in any consequences for your program involvement. We won’t ask you any really sensitive questions, but we will be asking about your mental health attitudes and experiences. Should you feel you need support, please refer to the Kids Help Phone Resources Around Me page to find available mental health resources. You may also connect with Kids Help Phone directly by phone (1-800-668-6868) or text (text CONNECT to 686868). If you are in crisis, please call 911 or go to the nearest hospital, police station or crisis centre. If you have any questions about the survey or data storage, please feel free to reach out to Jack.org’s evaluation team at evaluation@jack.org or our Chapters team at chapters@jack.org. For more information, please click here . (Note that if you are unable to access the link, it likely means your school has blocked any documents from other organizations. If you would like to read the full consent form, please email evaluation@jack.org.) If you consent to participating, please click the “next” arrow to begin the form! Q2. Please provide us with the following information. Note: First name will be used for things such as email correspondence. Please provide the name we should address you with. We use birth date to identify if you are already in our database or not. First Name Melissa Last Name Rodriguez Birthdate (yyyy-mm-dd) 2003-07-26 Phone 5483885077 Email address mnb120354@gmail.com City Seaforth Postal code N0K1W0 Q1. Province/territory Ontario Q8. What is your role in your Chapter? General Member (all other youth members) Q9. What is your previous involvement with Jack.org? (Select all that apply) I have not been involved with Jack.org before

Q36. When your Program Coordinator reaches out to your Chapter, would you like to be included in those emails? Yes All those involved in Jack.org activities must agree to abide by the terms of our Jack.org Network Code of Conduct. Network Code of Conduct In keeping with our mission to empower a national network of young leaders, Jack.org has created a Code of Conduct (referred to as our “Code”) to ensure all Jack.org activities are based on mutual respect and a sense of personal wellbeing. Our Code embodies our organizational values of: Engage with Empathy, Respect, and Kindness – We endeavour to always be thoughtful and act from a place of empathy and concern towards others and ourselves. We engage with our youth network,colleagues, stakeholders, and partners with an open heart and mind. Always listening,we create safe spaces so everyone, from all backgrounds, can feel comfortable expressing their authentic selves. Collaborate with Curiosity – We work to overcome challenges as one unified team- strengthened and informed by diverse perspectives. With humility, we acknowledge that we do not have all the answers. We actively collaborate to seek a variety of ideas, perspectives,lived experiences, and professional expertise. Youth Front and Centre – We ensure youth are always front and centre. We support,train, and empower their peer-to-peer education and advocacy efforts. We elevate youth perspectives, actively seek out marginalized voices, build leadership skills, and amplify the advocacy work of our network. Innovation-Focused & Evidence Based Impact – We always look to raise the bar to distinguish ourselves as one of the most innovative organizations in our sector and beyond. Through continuous learning and reflection we pave our path forward, always evolving our evidence-based practices to drive impact-focused improvement on youth mental health and well-being. Terms of Conduct Our Code applies to all Jack.org programmatic activities whether they are held on Jack.org property, online, during travel to Jack.org events, and/or at any affiliated offsite events. This Code exists to ensure that all of our programs run safely and effectively and that all participants have a positive experience. If anyone is unable to abide by our Code, their program status may be reassessed at any time. Standards of Behavior As part of participation in Jack.org programs, all young leaders agree to: Conduct themselves as representatives of Jack.org when participating in events. Be familiar with and abide by all Jack.org policies, rules and regulations, as well as all applicable federal, provincial, and municipal laws. Attend all scheduled activities on time and participate fully. Wear proper attire (not attire that is vulgar or obscene) and monitor personal hygiene. Demonstrate honesty and integrity, respect differences in people, ideas, and opinions, and respect the rights of all people regardless of differences in gender, age, sexual orientation, disability, physical appearance, body size, race, culture, religion. Engage in appropriate, respectful communications whether in-person, printed, distributed electronically. Show proper care for all facilities by not committing vandalism or willful destruction of property and be responsible for any damages. Seek help in responding to potentially violent and disruptive behavior from either Jack.org or local authorities. Be forthcoming with information regarding violations of the Code to Jack.org staff, a volunteer, or designated chaperone and immediately report any observations of another participant with a weapon or other banned/illegal substance. Ask any questions regarding the Code or appropriate conduct if they don’t understand. As part of participation in Jack.org programs, all young leaders agree not to: Harass, threaten, bully, haze, intimidate, or embarrass anyone when carrying out Jack.org activities and/or conducting themselves as representatives of Jack.org. Engage in any unwanted or unwelcome sexual attention/contact, whether physical or verbal. Engage in any cyberbullying, misuse any cell phones, cameras, computers, websites, or other electronic resources. Post, transmit, promote, or distribute anything that is illegal, harmful, abusive, vulgar, offensive, sexually explicit, or in a reasonable person’s viewpoint, objectionable. Use vulgar, offensive, and/or inappropriate gestures. Commit any illegal act. Pretend to be anyone whom they are not.

The second video below talks about what to do during a mental health conversation and teaches you how to use the “Engage, Validate, and Support” framework. There are examples for three different types of mental health conversations. If you want to learn more about safety in conversations around mental health, click here , talk to your Program Coordinator or visit www.bethere.org In this section, we will ask you questions about how you identify. In our commitment to equity and inclusion, we are gathering this data to help us (1) better understand the youth we work with, (2) identify the gaps in our programming, and (3) build pathways to break down barriers to participation. This data will also allow us to represent what we learn through our surveys and represent those findings more accurately. We understand that can be sensitive information, so we want to reassure you that this information will remain confidential and secure. Please feel free to select ‘prefer not to say’ if you feel uncomfortable answering any of these questions. Q2. How do you currently describe your gender identity? Select all that apply. Woman Q3. Do you identify as transgender? No Q23. What are your pronouns? She/her Q4. How do you describe your sexual orientation? Select all that apply. Straight Q5. Which of the following languages do you speak fluently? Select all that apply. English Q6. What is your preferred language of communication with Jack.org? English Q7. With which ethnic or racial groups do you identify? Select all that apply. Latin American (e.g. Bolivian/Guatemalan/Mexican) White (e.g. North American/Western European/Eastern European)

Q8. Do you identify as… (select all that apply) An immigrant Q9. Do you identify as someone with a disability? No Q10. Do you identify as someone who has lived experience with a mental illness or a mental health struggle? No Q11. In the last year, to what extent have you faced financial barriers (for example, in housing, education, or access to food)? To a large extent Q12. Please select the statement that best describes the area where you live. Rural Area Q40. Thank you for filling out the registration form. Please sign your name below to signify that you have: thoroughly read through the code of conduct; have answered the survey questions honestly or to the best of your ability; have watched the Mental Health 101 Video and Safety Video . Scoring Score: 0