Minnesota Suicide Prevention Regional Coordination Technical Assistance Request

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* 1. Contact information of person submitting request:

Name

Organization

City/Town

County

Email Address

Phone Number

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* 2. Please identify your Regional Coordinator (reference map is below)

Northwest: Tim/Brenna

North: Brina

Northeast: Molly

North Central: Destiny

East Central: Brianne

East Metro: Alyssa

Upper Western: Tamara

Central: Abigail

West Central: Adam

South Central: Grace

Southwest: Anna Grace

Southeast: Sara

Tribal (Southern-Lower Sioux, Prairie Island, Shakopee Mdewakanton, Upper Sioux): Adam

Tribal (Northern-Bois Forte, Fond du Lac, Grand Portage, Leech Lake, Mille Lacs, White Earth): Evie

Tribal (Northern-Red Lake): Lisa

Other (please specify)

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* 3. Please check and/or describe the assistance you would like from your Suicide Prevention Regional Coordinator

Technical Assistance: You are working on suicide prevention and would like guidance/support on how to do something (ex. policies/protocols, coalition-building, best practice strategies, postvention planning or response support, etc.)

Training: You are looking for a specific suicide prevention/intervention/postvention training for a group of people

Presentation: You are looking for a presentation about suicide prevention regional coordination or 988

Collaboration Opportunity: You are looking to network and/or get connected to others doing suicide prevention work in your region

Question/Information: You have a general suicide prevention question, or are looking for specific suicide prevention information

Other

Please provide any specific details about your request:

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* 4. What type of commitment are you looking for related to this request?

One-time request (join one meeting, provide a resource, do one training)

Multiple time commitments, but short term

Multiple time commitments, but longer term

Other (please specify)

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* 5. Can you share some background that has led up to your request?

A grant staff member or your Regional Coordinator will connect with you within 1-5 business days from your submission. Thank you!