Community Outreach Request Form [En Español] Community Outreach Request Form Thank you for your interest in Suicide Prevention Service and our community education and outreach opportunities. Please select from the options below and enter as much information as possible, and a staff member will be in touch with you shortly. You may also call our office directly at (831) 459-9373 or email sps24hr@gmail.com. * = required field I would like to: * Speak with a staff member to learn more Schedule one or more presentations or trainings for my school/organization/agency Receive educational outreach materials Have Suicide Prevention Service host a booth or table at a community event Name * Name * I would prefer to be contacted in: * English Spanish OtherOther I would prefer to be contacted by: * Phone Email No preference Phone Number * Phone number is: Cell Work Home OK to leave a message on this number? * Yes No The best times to reach me by phone are: Email Address * Enter Email Confirm Email Address * Confirm Email Please tell us a little bit about what you are looking for/what questions you have. Name of school/organization * Preferred dates and times Name of school/organization * Address of school/organization * Address of school/organization Address of school/organization Address of school/organization City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Zip This presentation is for (please check all that apply): Students Staff Option 3 Clients OtherOther Estimated number of expected participants Number of presentations you are requesting Please include any additional comments/information here. (If you specified "Other" for audience, please explain here.) English-language youth brochures (specify quantity) Spanish-language youth brochures (specify quantity) English-language adult brochures (specify quantity) Spanish-language adult brochures (specify quantity) Business cards (a.k.a. STOP cards) with the suicide crisis line number (specify quantity) Please include any additional comments/information. Name of event Date of event * Start time 121234567891011 : 000510152025303540455055 AMPM End time 121234567891011 : 0030 AMPM Staff should arrive to set up the table by 121234567891011 : 0030 AMPM Estimated number of expected participants Location of Event * Location of Event Location of Event Location of Event City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Provided at the event Chairs Tables Canopy Please Note: This form is not intended for crisis or suicide intervention and is not monitored 24 hours a day. 24 hour toll-free Suicide Crisis Line (877) 663-5433 (ONE-LIFE) / (877) Serving Monterey, Santa Cruz, and San Benito Counties for over 50 years reCAPTCHA
