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2. 

4. WHAT IS QPR?

   QPR – Question, Persuade, and Refer – is suicide prevention training designed to give every person in our community the confidence and competence to help someone at risk for suicide.

   Parents, friends, neighbors, teachers, ministers, doctors, nurses, office supervisors, squad leaders, foremen, police officers, advisors, caseworkers, firefighters, and other community members – anyone can learn these 3 simple steps that teach you how to recognize the warning signs, offer hope, and get help.

   KEY COMPONENTS COVERED IN TRAINING:

   • How to Question, Persuade and Refer someone who may be suicidal
   • How to get help for yourself or learn more about preventing suicide
   • The common causes of suicidal behavior
   • The warning signs of suicide
   • How to get help for someone in crisis

   To request a free one-hour QPR Gatekeeper training for your group, please fill out the following form. For a response, please allow up to two weeks. 

6. Full Name*
7. Email Address*
9. Position / Title
10. Organization*
12. Contact Phone Number*
14. Workshop Setting Preference*

    1. In-person
    2. Online
15. Number of Expected Participants*

    Please provide an estimate of the expected amount of individuals to be trained.

16. Privacy Setting*

    1. Public - others can join
    2. Private - you have selected group

    Please select whether you would like to open this free training opportunity to others or if you already have a group in mind.

    Min. 8 - Max. 35

18. Desired Date*
    Desired Date
19. Alternate Date
    Alternate Date
20. Time of Day*

    1. Morning
    2. Mid-day
    3. Evening
    4. Other
21. Preferred Time
23. Venue Location
24. Venue Address
26. City
27. State
28. Zip Code
30. Workshop Language*

    1. English
    2. Spanish

    Please select the preferred language for the workshop.

31. Available Trainers (E)
    -- Select One --Select OneNo Preference - anyMariah D.Fernando G.Jimmy G.M. Andrea C.Heide G.Kirsten A.Jessica F.Jannette S.Anthony A.Jaime O.Rebecca L.Tessa P.Amber S.Lino S.Ken R.Kayla I.Megan W.Susan M.Mike L.Bernadette C.Matt P.Dayana R.

    Please select from the list of available English-Speaking trainers.

32. Available Trainers (S)
    -- Select One --Select OneNo Preference - anyFernando G.Jimmy G.Lino S.M. Andrea C.Mariah D.Dayana R.

    Please select from the list of available Spanish speaking trainers.

    
    

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