Bi-Monthly Task Force Speaker Form

Bi-Monthly Task Force Speaker form

Please fill out this form if interested in speaking at our bi-monthly community meeting. A speaking engagement typically lasts 30-45 minutes. The goal of these meetings is to provide the community a resource in the space of suicide prevention.
The Delaware County Suicide Prevention Awareness Task Force (DCSPATF) functions to reduce the loss and suffering caused by suicide and suicidal behavior. The Delaware County Suicide Prevention Awareness Task Force is in the business of prevention, intervention, and post-intervention program implementation, facilitation, and promotion. The Delaware County Suicide Prevention Awareness Task Force offers information and education about, and assistance and support to, efforts to lessen the incidence of suicide and the stigma associated with suicide and suicide loss.
Name

First NameLast Name
What is your Organization?
Email
example@example.com
What is your website?
Do you have any social media handles you would like to share?
Experience Background (choose as many that apply)

Lived ExperienedProfessionalOther
If 'other' from previous question, please specify:
Have you or anyone in your family/community been impacted by loss due to Suicide? (Please specify in 50 words or less)
What is the title of your presentation?
Please list four areas that you would like to speak to:
Who is your target audience and age group of focus?
How would your topic connect and support our bi-monthly discussion?
Is there anything else you would like to include?
Please attach your resume or CV

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Thank you for filling out this form. We will be in contact with you shortly regarding next steps.

In the meantime, chek out our mission statement, to ensure our vision aligns with the message you would like to share with the community.

The Delaware County Suicide Prevention Awareness Task Force
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Bi-Monthly Task Force Speaker form