Mini Sources of Strength Training Request Form 2022/2023

Mini Sources of Strength Training Request Form

2022/2023
Please use this form to request a free youth suicide prevention training for your school or community organization. If you would like to request more than one training, please submit a separate request.

Mini Sources of Strength

The Mini Sources of Strength training is a condensed and abbreviated Sources of Strength Peer Leader training. This training is available for non-school youth groups, e.g. 4-H, after school programs, Boys and Girls Clubs, etc., and secondary school health classess. Through this interactive and engaging training, youth learn to engage with the eight protective factors, depicted in the wheel of strength and how to identify and reach out to trusted adults.

The training is 1 to 2 hours, can be facilitated in-person or virtually, and can be tailored to specific audiences. The training is for youth 24 years or younger.

Please note:
1. If you would like to request a training time shorter than the minimum time commitment, please use the "Special Requests" question to explain why.
2. Community members are welcome and encouraged to attend trainings.

Section 1. Contact Information
School or Organization Name*
Contact Name *

First NameLast Name
Contact Title*
Phone Number (reachable day of training)*

Area CodePhone Number
Email (reachable day of training)*
example@example.com
Time zone*
Name of training location*
Training location address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Section 2. Training Information
Please select your top three training dates with preferred start times (keep in mind schoolwide events or activities that may limit staff or student attendance).
1st Date*

MonthDayYear
DateHourMinutesAM/PM Option
2nd Date*

MonthDayYear
DateHourMinutesAM/PM Option
3rd Date*

MonthDayYear
DateHourMinutesAM/PM Option
Please select your preferred training format.*

In personVirtual via Zoom

Section 3. Training Demographics
Number of anticipated participants. *
Will there be any participants under age 18?*

YesNo
Please provide the grades or age range of participants under age 18.*
Will there be any participants between ages 18 - 25?*

YesNo
Please specify any special requests for accommodations.
Please describe any recent losses (suicides or sudden deaths) or major changes to the school or organizational climate we should be aware of.
Should be Empty: