Howard County Health Department - Youth Suicide Prevention Presentations & Materials
Thank you for your interest the Howard County Health Department (HCHD) Youth Suicide Prevention campaign. Please complete this Presentation & Material Request Form. If you are requesting to host a presentation, please complete the form 30 days prior to the event date.

Questions may be directed to Colleen Nester, Youth and Family Support Services Supervisor, at cnester@howardcountymd.gov.
Which aspect of the Youth Suicide Prevention Campaign are you requesting? Please check all that apply. *
Required
If you are requesting to host a community presentation, please provide the name & a brief description of your organization.
Event Name
Event Date
MM
/
DD
/
YYYY
Event Start Time
Time
:
Event Address
Please select which printed materials are desired.
Please provide the preferred quantity for desired materials (Maximum quantity: 50 per material).
Your name *
Phone number *
E-mail *
Preferred contact method *
Required
Questions and comments
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