ASIST suicide prevention training

Registration Form

Please fill out this form to register for the ASIST 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.

Trainers: Angelina Tso and Shoshana James
Date: May 18 & 19, 2026
Time: 8:30 AM - 4:30 PM (MST) BOTH days
Location: Moonshot Accelerator's Main Conference Room 2225, N. Gemini Rd, Flagstaff, AZ 86001

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

ASIST suicide prevention training

Registration Form

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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:

ASIST suicide prevention training

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:

2. Name: (Required.)

3. Email: (Required.)

4. Phone (optional):

5. Company/Organization: