Basic Information
Full Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Demographic Information
Age Range
18–24
25–34
35–44
45–54
55–64
65–74
75+
Other
Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Faith/Spiritual Affiliation
Atheism
Buddhism
Christianity
Hinduism
Islam
Judaism
No Affiliation
Sikhism
Spiritual but Not Religious
Other
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Program Relevance
What is your current role/title
Advocate
Counselor
Educator
Mental Health Professional
Pastor
Survivor
Volunteer
Other
How does your role relate to your interest in this program?
Have you been personally impacted by suicide (yourself, a loved one, or within your community)?
Yes
No
Prefer Not to Say
What aspect of faith-based suicide prevention interests you most?
Supporting loved ones struggling with suicidal thoughts
Faith-based crisis intervention skills
Integrating mental health for spiritual healing for holistic well-being
Understanding the intersection of faith and mental health
Learning how to create suicide-safe spaces in my church, community or organization
Other
What do you hope to gain from this training?
What challenges do you face in addressing mental health or suicide prevention within faith communities?
How familiar are you with suicide prevention strategies?
Beginner (I have little to no prior knowledge)
Intermediate (I have some experience or training)
Advanced (I work in this field and have extensive experience)
Other
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Availability and Preferences
Preferred Learning Style
Blended Learning
Hybrid
Live Sessions
Self-Paced
Workshops
Other
Best Days/Times for Sessions
Evenings (Weekdays)
Mornings (Weekdays)
Weekends
Weekdays Only
Flexible Schedule
Other
Preferred Communication Platform
Email
Phone Call
WhatsApp
Zoom
Other
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Marketing Insights
How did you hear about this training?
Church
Email Invitation
Flyer or Poster
Friend Referral
Online Advertisement
Social Media
University Notice Board
Website
Other
Would you be interested in future faith-centered mental health trainings?
Yes
No
Maybe
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Accessibility and Support Needs
Do you have any accessibility needs or accommodations we should be aware of to ensure full participation?
ASL interpretation
Braille Translation
Closed captioning
Tech assistance
Other
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Commitment and Follow-Up
Are you ready to commit to participating in this program? (Yes/No/Maybe)
Yes
No
Maybe
Do you need additional information before making a commitment?
Yes
No
Please specify
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Optional Information
Social Media Handles (if relevant to engagement)
Would you be interested in joining a follow-up support group or faith-based peer network after the training?
Yes
No
Maybe
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