QPR Request Form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

QPR Request Form

The HelpLine Suicide Prevention Team is happy to present QPR to your organization/group! Please fill out this form with your contact information as well as the top 3 days and times that you would like to schedule your QPR Gatekeeper Training for.

We will do our best to respond within 48 hours of your request. Thank you!

For more information about the HelpLine Suicide Prevention Program or QPR, please visit: https://helplinedelmor.org/prevention-education-training/suicide-prevention-training/

Email *

Your name: *

Name of your agency or group: *

Estimated size of group: *

Are you interested in an in person or virtual QPR training? *

In-person

Virtual

Both

If you chose in-person, where will the training take place?

And will there be a large TV or projector that can be used to display the slideshow presentation?

What is your most preferred day and time? *

YYYY

Time

What is your second preferred day and time? *

YYYY

Time

What is your third preferred day and time? *

YYYY

Time

Do you require any special accomodations? *

If you have any questions, please contact: suicideprevention@helplinedelmor.org

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of HelpLine of Delaware and Morrow Counties, Inc..

Does this form look suspicious? Report

Forms