Thank you for your interest in submitting your story of success, innovation, and/or impact for your suicide prevention efforts. The Suicide Prevention Resource Center (SPRC) is looking for stories of innovation and impact to share with the broader suicide prevention field. Your stories can serve as inspiration for others. Since demonstrating success, innovation, and/or impact in the suicide prevention field can be challenging, we encourage you to share your story however small or big of an impact you think you are having.

This questionnaire serves as an opportunity for us to learn more about your work and it should only take about 5-10 minutes to complete.

Please note that at this time, not all the stories will be featured. However, we will be keeping a record of all the stories and would be grateful for the opportunity to check back in with you for future opportunities to feature your story.

If you have questions about this questionnaire, please contact Bonnie Lipton at BLipton@edc.org. 

Thank you for your time!

-SPRC

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* 1. Contact Information:

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* 2. Please briefly describe any successful and/or innovative suicide prevention effort you’d like to share with us. (Please include your target population, relevant partners, implementation strategies, how long the effort has been taking place, and any other relevant details you’d like to share.)

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* 3. What are the two to three most important lessons you learned from your experience implementing this suicide prevention effort?

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* 4. Do you have any process or outcome measures you’ve collected for this suicide prevention effort? If so, please briefly describe what type of data you’ve collected. 

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* 5. Do you have any data on how your suicide prevention efforts have impacted suicide deaths and/or attempts in your systems or community? If so, please briefly describe what type of data you’ve collected.

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* 6. Have the suicide prevention efforts you shared with us been supported by any grant or foundation funding (e.g., SAMHSA, IHS, NIMH, HRSA)? If so, please specify which grant.

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* 7. Has your organization published or presented externally about this suicide prevention effort? If so, please specify where this information has been featured.

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* 8. If you are a Garrett Lee Smith or National Strategy for Suicide Prevention grantee, will you be uploading any materials to the Grantee Private Pages which further demonstrate your success and/or impact story provided?

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