Real Talk: Navigating Life's Hard Moments Together
Question, Persuade, and Refer (QPR) Gatekeeper Training
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First Name
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Last Name
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Email address
What is your ethnicity/race? Please check all that apply.
African American/Black
Asian/Asian American
Hispanic or Latino/a
Native American/American Indian
Native Hawaiian or Other Pacific Islander
White/Caucasian
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Other
Please select your gender.
Female
Male
Nonbinary
Transgender Female
Transgender Male
Gender Variant/Non-Conforming
Not sure
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Other
What organization do you work for?
What is your job title?
Which category of health professional best describes you?
Please Select
Behavioral Health Professional
Physician
Physician Assistant
Nurse
Other
If you selected "Other" above, please enter the category of health professional that best describes you below.
What workshop training date do you plan to attend?
*
December 11, 2025
December 18, 2025
Other, please specify:
How did you hear about this event?
Please Select
Let's Talk campaign
NCCPRW
NCPHP
UNC Health Southeastern
Scotland Health Care System
Other:
If you selected "Other" above, please let us know how you heard about this event below.
Do you have any special requests for the speakers regarding the topic?
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