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Thank you for your interest in MHA’s Bell Seal for Workplace Mental Health. By submitting the following form, you are completing the first step towards Bell Seal certification for your workplace. The information you provide will help us determine how to help you navigate the application process. If you have any questions about the form, please contact Taylor Adams at workplace@mhanational.org.

Applicant on Behalf of Employer

Organization Information

Physical Address
Mailing Address (If different from physical address.)
Please select the primary industry for your organization:
Please specify
Please enter the breakdown of employee status by percentage of full-time employees, part-time employees, and independent contractors. 
Why is your organization interested in the Bell Seal for Workplace Mental Health? Please check all that apply.
How did you hear about the Bell Seal for Workplace Mental Health?
(Please specify.)