Question, Persuade, and Refer (QPR) for 2SLGBTQIA+ Communities

Registration Form

Please fill out this form to register for the QPR training.

Participants must remain for the entirety of the training in order to receive a certificate of completion. Participants who are more than 15 minutes late to the training will have to reschedule for another day.

Trainer: Angelina Tso
Date: June 17, 2026
Time: 1:30 - 2:30 PM (MST)
Location: East Flagstaff Community Library, 3000 N 4th St, Suite 5, Flagstaff, AZ 86004

Question Title

1. Pre and post the training, we would like to conduct a pre/post survey to assess whether there was an increase in your knowledge due to this training. Your participation in this training and pre/post survey is completely voluntary. Participant names in these trainings will comply with the HIPPA/privacy/confidentiality. Confidentiality will be maintained by means of locking all original forms and notes in a cabinet in a locked room.

I agree to the collection of demographic data that will be utilized to inform programmatic outreach.

Yes

Question, Persuade, and Refer (QPR) for 2SLGBTQIA+ Communities

Registration Form

Question Title

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2. Name: (Required.)

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3. Email: (Required.)

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4. Phone (optional):

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5. Company/Organization:

Question, Persuade, and Refer (QPR) for 2SLGBTQIA+ Communities

Registration Form

Question Title

Question Title

* 2. Name: (Required.)

Question Title

* 3. Email: (Required.)

Question Title

* 4. Phone (optional):

Question Title

* 5. Company/Organization:

2. Name: (Required.)

3. Email: (Required.)

4. Phone (optional):

5. Company/Organization: