ASIST Application Form

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This training is currently full; please complete the form to be added to the waitlist. Thank you!

May 8 & 9, 2024

8:30am-4:30pm (in-person)
United Way of Northwest Vermont Offices 412 Farrell St # 200, South Burlington, VT 05403

This free training is hosted by the Vermont Collaborative for Practice Improvement & Innovation with support from the Vermont Department of Mental Health, American Foundation for Suicide Prevention Vermont Chapter, Rotary Club of St. Albans, and United Way of Northwest Vermont. There are limited seats available. Applications submitted by 4/26 are given priority. CEUs are available for licensed professionals.

About ASIST
LivingWorks ASIST is a two-day in-person workshop featuring powerful audiovisuals, discussions, and simulations. At a LivingWorks ASIST workshop, you’ll learn how to recognize when someone may be thinking about suicide, and how to provide a skilled intervention and develop a safety plan with the person to connect them to further support. You will also consider how personal and community attitudes about suicide affect someone’s openness to seek help and your ability to provide it. This workshop will increase your willingness, confidence, and capacity to provide suicide first aid.Two knowledgeable, supportive trainers will guide you through the course, ensuring a comfortable and safe learning environment. For more information, visit the LivingWorks website.

Email *

First Name (Pronouns) Last Name:
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Phone Number:
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Title & Organization:
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Role (please check all that apply):
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Community Advocate for Suicide Prevention

Licensed Mental Health Care Provider (ex: LCMHC, LCSW, LDAC, Psychologist, School Counselor)

Licensed Health Care Provider (ex: Physician, Nurse, PA, ANP)

Peer Mental Health Worker

Teacher/Educational Professional/Administrator

Graduate Student/Counseling or Healthcare Intern

Rostered Non-Licensed, Non-Certified Psychotherapist

Other:

Required

License Type (if applicable):

Tell us more about why you would like to participate in this course?
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Do you have any prior experience with suicide prevention training?
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What audience(s) do you plan to serve with this training?
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Do you have any questions/comments? Are you requesting any accommodations to participate?
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There is typically a fee to attend ASIST. However, this program is fully-funded for participants and includes all materials and meals at no cost. We want to be sure to fill every seat to maximize the impact. Are you able to commit to attending both full-day sessions? If your availability changes, will you contact VCPI as soon as possible so that we may offer your place to another interested community member?
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Yes

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