I’m Living Proof Submission

I am between the ages of 18 and 35

I have experience living with a mood disorder

I am willing to publicly self-identify as an individual living with a mood disorder

Please let us know who you are!

First Name:

Last Name:

Email:

Street 1:

Street 2:

City:

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ZIP:

Phone Number:

Date of Birth:

Yes, I would like to receive e-mail from Depression and Bipolar Support Alliance

Tell your story!

Videos should be 7 minutes or less in length.

Note: Videos cannot be attached. You must provide us with a link to view your video on a separately hosted site such as YouTube, Vimeo, or other preferred site.

Written stories should be 1500 words or less.

Note: If you're submitting a written story, please write it separately in a preferred text editor (Word, etc) and then copy and paste into this window. You will not be able to save this information and return at a later time to finish.

If you're sharing a video, please paste the link below:

If you are sharing a written story, please paste it in the window below.

REMINDER: please write your story separately in a preferred text editor (Word, etc) and then copy and paste into this window. You will not be able to save this information and return at a later time to finish.