ASIST Survey

ASIST Survey Form

We are asking for your feedback. The data on the survey will be used by SaveCenla to gather information for statistical purposes only. Thank you for taking your time to help saves lives.
Today's Date

Month Day Year
Date
Your Name *

First Name Last Name
Email *
example@example.com
Phone Number
Please enter a valid phone number.
ASIST Training Location *
Training Date *

Month Day Year
Date
Describe your training experience: *
Have you used this training in your personal life?

Yes No
Have you used this training in your professional life?

Yes No
How many times have you used this training?

Once 2 - 5 6 - 20 > 20
Has someone with thoughts of suicide benefited from you being ASIST trained?

Yes No
If yes, please explain:
Would your intervention have been different without the ASIST training?

Yes No
If yes or no please explain:
How would you rate ASIST training? *
How likely would you recommend someone taking ASIST training? *

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Does SaveCenla have your permission to use your testimony to promote ASIST? *

Yes No
Does SaveCenla have your permission to use your name? *

Yes No
Thank you for your input! SaveCenla and others just like you are committed to lift the stigma of mental illness so that our home can become a suicide-safer community.

SaveCenla Tax ID #81-4863849
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ASIST Survey Form