Mental Health First Aid Registration (9/29/21)

Please take a few moments to answer the registration and demographic questions below. Feel free to respond, "prefer not to answer" to any of the questions if you choose.

The data is invaluable as it enables us to show the long-term impact of MHFA Trainings in Ohio and that we are reaching key high-risk populations. Your answers will only be shared internally at OSPF and will be completely de-identified when sharing with partners.

*1.What is your first name?(Required.)

*2.What is your last name?(Required.)

*3.What is your email address?(Required.)

*4.What is your company/organization/agency name?(Required.)

*5.What is your professional title?(Required.)

6.Please select your race:

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Prefer Not to Answer

Other (please specify)

7.Please select your ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Prefer Not to Answer

8.What is your sex?

Male

Female

Prefer Not to Answer

Other (please specify)

9.What is your gender (select what you most identify with):

Woman

Man

Transgender

Questioning

I don't know

Prefer Not to Answer

Other (please specify)

10.What is your sexual orientation (select what you most identify with):

Heterosexual/straight

Lesbian

Gay

Bisexual

Questioning

I don't know

Prefer Not to Answer

Other (please specify)

11.What is your age?

12.Have you ever served as a member of the military?

Yes

13.Do you have a family member that currently serves in the military or is a veteran?

Yes

14.Do you have a friend that currently serves in the military or is a veteran?

Yes

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