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Section 2 of 2
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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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Students
Parents/Families
Employees
Corporate Executives
Mental Health Professionals
Government Officials
First Responders
Faculty/Staff
Open to local community
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50-100
101-150
151-200
200+
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Yes, on site
Yes, at a location nearby
Unsure at this time
No, we would like help finding space
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The screening space is or can easily become A/V equipped
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 would like to invite a licensed mental healthcare professional from our organization/affiliated with our organization to serve on the post-screening discussion panel.
We have access to media & public relations outlets.
We will be managing our own event registration process.
We have a budget to fund educational/awareness events such as this.
We would likely seek funding to host this 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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Preferred Date
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Is there a designated space available to accommodate the screening & panel discussion?
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Please check all that apply
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