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PROVIDE BACKGROUND TO BETTER UNDERSTAND YOUR NEEDS.
* Required
Email address
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
Your answer
Company, Organization or Affiliation (if applicable)
Your answer
I Identify As:
*
Suicide Attempt Survivor
Bereaved by Suicide
Experienced Suicidal Thoughts and Feelings
Clinician/Healthcare/Crisis Responder
Ally/Advocate
Researcher
Impacted Family or Friends
Other:
Required
Lifecycle: Which best fits where you are at? See more at
unitesurvivors.org/lifecycle/
*
I'm New: What do I need to know
I'm Ready: Help me get started
I'm Frustrated: But not ready to give up
I'm Retiring: How do I leave a legacy
Other:
What motivated you to join our mailing list?
Your answer
OPTIONAL: If you have been personally affected by suicide, have you told your story before? If yes, to who?
Your answer
OPTIONAL: If personally affected by suicide: What if any, were/are the biggest challenges of sharing your story?
Fear of rejection or judgment
Fear that I wouldn't be clear or make sense
Fear that I wasn't doing it right according to the "rules"
Finding a place to share it publically
Public speaking
Other:
OPTIONAL: If you have told your story: What, if any, were the positive benefits of sharing your story publicly?
Your answer
Have you visited/followed our YouTube (
bit.ly/UniteSurvivorsYouTube
) and Social Media (
twitter.com/unitesurvivors
and
facebook.com/unitesurvivors
and
instagram.com/unitesurvivors
)?
*
No, not yet
Yes, I'm on it!
Will Do!
Other:
Required
OPTIONAL: What should we be considering that you think is important or overlooked in the field of suicide prevention from moving forward?
Your answer
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