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Let's Plan Your Next Dynamic Mental Health Event! Please fill out the form and answer all questions as much as possible.
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1
What is your first and last name?
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First Name
Last Name
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2
What is your email address?
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What is the BEST phone number to reach you?
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4
What is your title, or role?
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5
What is the name of your institution?
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6
What services are you most interested in? Check ALL that apply
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Speaking Services (virtual)
Training Services (virtual)
Consulting Services (virtual)
Speaking Services (in-person)
Training Services (in-person)
I'm not sure!
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7
Who are the requested services for?
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Students
Employees
Other
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8
What is the main objective or goal of your request? Check ALL that apply
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To address mental health stigma
To address loneliness and isolation
To address low utilization of support services (i.e. counseling, EAP, tutoring, etc.)
To address poor stress management and coping skills
To address employee burnout
To address low attendance/engagement
To address suicide, suicidal behaviors, or self-harm
To address lack of mental health education
Other
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9
What outcome(s) are you hoping to achieve with this event?
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10
What is your set date? Enter N/A if you don't have a date yet.
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If you have a specific event date request, please list it below.
Date
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11
Is your date flexible?
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Yes
No
I don't have a date yet
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12
Do you have a budget for our services?
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No
I'm working on it
I need help securing funding
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13
Are there any specific concerns or questions you have about our services?
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14
How did you hear about Speaks 2 Inspire? Select all that apply.
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Please specify the referral source, we may have deals available based on the referral
Founder, Abraham Sculley
Previous Client
Social Media (IG, LinkedIn, FB)
S2I Referral Partner
Website
I am a JED Campus!
Google Search
Email Newsletter
Other Referral
Other
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