BIPOC Trainer Collaborative Form

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Black, Indigenous, and People of Color (BIPOC) Trainer Learning Collaborative!

Calling all BIPOC instructors and facilitators who focus on mental health and suicide prevention. This is a space dedicated to BIPOC instructors and trainers of various training programs to focus on:

Learning up to date best practices to optimize your trainings
Networking with other BIPOC instructors/facilitators
Increasing accessibility to relevant community-based trainings
Learning how to identify and decrease barriers to access to trainings and overall healthcare.

This is open to all BIPOC instructors, trainers, and facilitators of various training programs.

Please fill out this form to help us determine the best day/time for this meeting and to determine the most useful topics or support for this meeting.

Email *

Full name

Title/organization

What day/time typically works best for you to join this meeting? (Select all that apply)

2nd Tuesday of the month at 1:00 PM

2nd Tuesday of the month at 2:00 PM

2nd Wednesday of the month at 11:00 AM

2nd Wednesday of the month at 1:00 PM

Other:

Reason or hopes/goals for joining meetings:

Topics of interest or information that you would like to see discussed in meetings:

What is the most helpful to you for this meeting? (i.e. networking, discussing challenges, success, problem solving, connecting, social-emotional support, educational aspects, etc.)

Which trainings do you teach?

Do you have any personal or professional experience you would like to share with the group at an upcoming meeting? (We welcome experiences that help us grow as trainers and facilitators, as well as working with various communities-to inform better practices)

City

Please select your county *

Baker

Benton

Clackamas

Clatsop

Columbia

Coos

Crook

Curry

Deschutes

Douglas

Gilliam

Grant

Harney

Hood River

Jackson

Jefferson

Josephine

Klamath

Lake

Lane

Lincoln

Linn

Malheur

Marion

Morrow

Multnomah

Polk

Sherman

Tillamook

Umatilla

Union

Wallowa

Wasco

Washington

Wheeler

Yamhill

Other:

Required

How do you identify your race, ethnicity, tribal affiliation, country of origin, or ancestry?

Which of the following describes your racial or ethnic identity? Please check ALL that apply.

Asian (e.g. Asian Indian, Cambodian, Chinese, Communities of Myanmar, Filipino/a, Hmong, Japanese, Korean, Laotian, South Asian, Vietnamese, Other Asian)

Black and African American (e.g. African American, Afro-Caribbean, Ethiopian, Somali, Other African-Black, Other Black)

Hispanic and Latino/a/x (e.g. Central American, Mexican, South American, Other Hispanic/Latino/ax))

American Indian and Alaska Native (American Indian, Alaska Native, Canadian Inuit, Metis, or First Nation, Indigenous Mexican, Central American, or South American)

White and Caucasian (e.g. Eastern European, Slavic, Western European, Other White)

Native Hawaiian and Pacific Islander (e.g. Chamoru-Chamorro, Marshallese, Communities of the Micronesian Region, Native Hawaiian, Samoan, Other Pacific Islander)

Middle Eastern/North African (e.g. Middle Eastern, North African)

Don't want to answer

Other:

Speaker ideas, or other suggestions you would like to share:

Other:

Submit

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