QPR Training Interest Form - Oregon Suicide Prevention

Contact Info

Your Name (First and Last):*

Best phone number to reach you:*

Email address:*

How did you first hear about QPR and Lines for Life?*

Name of Organization (if not part of organization, please type NA):*

What is the zipcode of the PRIMARY location of this organization?:*

Which county or counties in Oregon do you or your organization serve?*

Type of Organization:*

Type of Organization (other):

Please indicate which demographic groups you or your organization provide DIRECT service to. Check all that apply.*

Which of the following best match your QPR training needs?*

Which of the following best match your organization's QPR training needs?

Approximately how many people from your organization are interested in receiving QPR training?*

Approximately how many people from your organization are interested in becoming a QPR Trainer?*

Would a virtual training work well for your organization?*

Are you currently providing virtual QPR trainings?*

Are you looking to provide virtual QPR training and would like support in accessing virtual materials?*

Do you have a physical location available where QPR training could be held?*

What is the address of this training space?*