Interest in T4T: Registration Survey

T4T Interested Applicants

Thank you for your interest in a T4T workshop. We do not currently have any T4T's scheduled, however we would love to take your information to keep on file. When a T4T is available, we will be sure to contact interested applicants.

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* 1. Please provide some basic information about yourself.

Name: *

Organization: *

Address:

Address 2:

City/Town:

State:

ZIP:

Email Address: *

Phone Number:

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* 2. Which T4T are you interested in? Check all that apply.

SafeTalk

ASIST

Connect

Lifelines Trilogy

Other (please specify)

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* 3. If interested in SafeTalk, let us know if you've taken an ASIST training course

Yes

I have an ASIST scheduled for

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* 4. What, if any, coalitions are you connected to?

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* 5. Have you ever had training on suicide prevention, intervention or postvention practices?

Yes

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* 6. How many people would you estimate are in your "professional reach" as a trainer?

0-30

30-60

60-100

100+

I don't know

Other (please specify)

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* 7. Which of the following choices below best represents how often you conduct training or present in any capacity?

Several times a week

Once every 2 weeks

Several times a month

Once every couple of months

Several times a year

I do not currently provide training/presentations

Other (please specify)

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* 8. Do you have any specific knowledge or experience that you bring to the table you want us to know about?

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* 9. What audience(s) do you generally have access to?

Mental health professionals

Health professionals

Teachers and school staff (K-12)

University/College campus staff

Youth (middle/high school)

Youth (college/university)

Various youth service providers (community center staff, youth group leaders, etc.)

Other (please specify)

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* 10. What is your biggest strength as a trainer?

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* 11. What is your biggest opportunity for growth as a trainer?

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* 12. How often do you anticipate being able to provide a training?

1-3 times per year

3-5 times per year

5+ times per year

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* 13. When I become a trainer, I will have the ability to train outside of my... (check all the apply)

Agency

County

Neither

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* 14. Do you have agency and/or supervisory support to become a trainer and meet any trainer expectations (min. number of annual trainings to remain certified, etc.)?

Yes

N/A

Question Title

* 1. Please provide some basic information about yourself.

Question Title

* 2. Which T4T are you interested in? Check all that apply.

Question Title

* 3. If interested in SafeTalk, let us know if you've taken an ASIST training course

Question Title

* 4. What, if any, coalitions are you connected to?

Question Title

* 5. Have you ever had training on suicide prevention, intervention or postvention practices?

Question Title

* 6. How many people would you estimate are in your "professional reach" as a trainer?

Question Title

* 7. Which of the following choices below best represents how often you conduct training or present in any capacity?

Question Title

* 8. Do you have any specific knowledge or experience that you bring to the table you want us to know about?

Question Title

* 9. What audience(s) do you generally have access to?

Question Title

* 10. What is your biggest strength as a trainer?

Question Title

* 11. What is your biggest opportunity for growth as a trainer?

Question Title

* 12. How often do you anticipate being able to provide a training?

Question Title

* 13. When I become a trainer, I will have the ability to train outside of my... (check all the apply)

Question Title

* 14. Do you have agency and/or supervisory support to become a trainer and meet any trainer expectations (min. number of annual trainings to remain certified, etc.)?

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* 15. Any other information you would like to share?