The purpose of this survey form is to allow you to provide us with a detailed understanding of your training needs and preferred arrangements to meet those needs. We will review your needs and then follow-up with you to discuss our ability to most appropriately fulfill your expectations.

Thank you for interest in preventing suicide in your community.

* 1. I would like to request training for the following group of persons (please click on the appropriate item so your request will be properly handled): Please note that TSPN has a policy NOT to train youth, as our efforts and grants are to target adults or adults working with youth.You may want to consider contacting the Jason Foundation ( as they provide a youth suicide prevention awareness training program that may fit your needs.

* 2. Please provide contact information for your organization. Be specific as to the exact contact person and physical site for this training request.

* 3. Please confirm that you will serve as the contact for this session.

* 4. Why are you (this group) requesting this training?

* 5. Have there been any recent suicide deaths in the community that have impacted you (this group)? We don't need details, just want to be aware.

* 6. Are there any specific directions necessary beyond what can be accessed via GPS or online mapping?

* 7. Please provide any specifics needed to reach training room (i.e. parking arrangements, building name/description if there are several, room number/floor, security checkpoints, etc.).

* 8. What time of day would you like this event to occur? Check all that apply.

* 9. Identify your top 3 possible dates for a training session - please ensure the preferred date options you provide are on different days if we have a scheduling conflict for one of your dates.

1st choice
2nd choice
3rd choice

* 10. For each training session, we need the following items in order to complete the training.

Which of the following do you need us to bring? Click all items that are needed.

* 11. TSPN staff will provide a two hour training based upon QPR. Please note feasibility for your request.

* 12. What is the amount of people we will be providing this training to? If your request is for less than 15 people, we find a regional member to provide this training or request that the participants attend a training held in the community.

* 13. Is there any additional information you believe necessary to meet your training needs?

If you have a specific trainer you would like to provide this training, please include their name here so we may determine if s/he is available.

You must click "submit" at the bottom of the page to proceed.