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Minnesota Suicide Prevention Regional Coordination Technical Assistance Request
1.
Contact information of person submitting request:
Name
Organization
City/Town
County
Email Address
Phone Number
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)
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:
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)
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!