QPR Volunteer Trainer Interest Form

Thank you for your interest in becoming a volunteer certified QPR trainer through Lewis and Clark Public Health’s (LCPH) Suicide Prevention Program.

Facilitators of this evidence-based suicide prevention model help spread the knowledge that suicide is preventable by teaching community members how to recognize the warning signs of a suicide crisis, and how to Question, Persuade, and Refer someone to help.

Once you become a certified trained, you’ll be able to train organizations and community groups within Lewis and Clark, Jefferson and Broadwater Counties on a schedule that works for you.

New QPR trainers are provided with facilitator training on the general model, which is self-paced through the QPR Institute, as well as a review of local statistics and how to present them. Trainers can also shadow and co-train with experienced facilitators to build confidence and understand how to respond to common questions.

LCPH covers the cost of the self-paced training and 3-year certification for qualified volunteers, who are expected to present at least 6 trainings per year.

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Agency (if affiliated with an agency)

Have you taken the QPR training before? If so, when (month and year)?*

Why are you interested in volunteering as a QPR trainer?*

Please tell us about your previous volunteer experience.*

We typically present to workplaces and community groups, and value trainers who have experience with any of the following.

• Churches and faith-based communities
• Schools
• Medical professionals
• Mental Health Professionals
• First Responders
• Parents Groups, for ex. PTA, PTO
• Tribal communities
• LGBTQIA+ community
• Firearm community
• Business owners
• Military and Veterans, Veterans groups
• Veterinarians and animal-related organizations
• Community groups – ex. Helena Kiwanis, book clubs, Hometown Helena, Helena Young Professionals, 4-H leaders

Please tell us about any groups you're affiliated with and if you may be able to help bring trainings to them.*

Are you able to commit to providing 6 trainings per year? We also ask volunteers to help connect us to possible training opportunities, as mentioned above.*

Please tell us briefly about your personal and/or professional experience with mental health and suicide prevention.*

Please provide the name and contact information for a professional reference we can contact. *

Is there anything else you'd like us to know?

Please verify that you are human*