QPR Training_Center Community

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Please use this form to register for the QPR (Question, Persuade, Refer) suicide prevention training. The training is free, and you will receive a $25 stipend for attendance and completion of the evaluation. Your certificate will be good for 3 years.

What Date are you registering for?

Nov 17, 5:45-7 PM; Center Community Room

February 3, 5:45-7 PM; Center Community Room

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What is your last name? *

What is your first name? *

What is your role in the community? *

Parent

Grandparent

Aunt/Uncle/Sibling/Family Member

Youth-Serving Professional

Business Owner

Youth above age 16

Other:

What would you like to gain from attending the training? *

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