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Contact Phone Number
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I am filling out this survey on behalf of a...
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College/University
Government Agency (local, state, or federal)
Hospital, Medical Center or Mental Health Services Provider
Corporation
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Host location (City, State)
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Estimated Target Audience (please check all that apply)
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Students
Parents/Families
Employees
Corporate Executives
Mental Health Professionals
Government Officials
First Responders
Faculty/Staff
Open to local community
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Estimated Audience Size
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50-100
101-150
151-200
200+
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Date Option 1
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Date Option 2
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Date Option 3
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How will this event be hosted?
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We will be using our organization's virtual meeting platform (Zoom, Webex, BlueJean, etc.)
We prefer to use The Quell Foundation's Zoom account
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Will you require attendees to register?
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Yes. We'll use our organization's registration platform
Yes. We'd prefer to use The Quell Foundation's EventBrite registration account
No. No registration required.
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We've identified a local mental health professional who will be in attendance to support the post-screening discussion.
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Yes
Not yet, but we will
We need help identifying someone
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Please check all that apply
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We have a designated team/point person to oversee promotion of the event.
We are looking to co-host the screening event with another organization.
We have access to media & public relations outlets.
We have a budget to fund educational/awareness events such as this.
We will likely seek funding to host this event.
This event will be part of a larger campaign/initiative/program at our organization.
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Please upload any logo(s) of the host organization. The Quell Foundation will use to produce branded materials for you to use in promoting the event.
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Contact Name and Title
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Contact Email
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Contact Phone Number
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I am filling out this survey on behalf of a...
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Host location (City, State)
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Estimated Target Audience (please check all that apply)
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Estimated Audience Size
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Date Option 1
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Date Option 2
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Date Option 3
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How will this event be hosted?
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Will you require attendees to register?
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We've identified a local mental health professional who will be in attendance to support the post-screening discussion.
No responses yet for this question.
Please check all that apply
No responses yet for this question.
Please upload any logo(s) of the host organization. The Quell Foundation will use to produce branded materials for you to use in promoting the event.