Name:
Email:
Phone:
Is there anyone else who may serve as Key Contact? If so, please provide their name and contact information here
Name of Group/Organization:
Best description of your group/organization: corporate/business community service organization health care faith community school, K-12 school, higher education law enforcement Other Best description of your group/organization:
Primary audience for training/presentation Workplace staff Health care providers First responders Faith leaders or faith community members Educators, Youth-serving professionals Parents/caregivers Youth (grades 6-12) Young Adults General Community Members Other Primary audience for training/presentation
If in person, what county are you located?
When would you like to host this training/presentation? Please indicate proposed date or window of time you prefer (ie. during the month of July, etc.)
What is proposed time for presentation? Daytime, M-F between 9:00am – noon Daytime, M-F between noon and 1:00pm Daytime, M-F between 1:00 – 5:00pm Evening, M-F between 6:00 – 8:00pm Other What is proposed time for presentation?
Please select: QPR- Question Persuade Refer (Suicide Prevention) Mental Health First Aid Youth Mental Health First Aid *for adult caregivers of youth
Please select: Supporting the Mental Health Needs of Your Community Supporting Youth Mental Health & Encouraging Resilience Stigma Stops with You (for youth & young adults) Supporting Mental Health in the Workplace Conversations on Wellness: Self-Care & Self-Compassion Feeding Your Flame: Addressing Signs of Burnout with Self-Care, Self-Compassion, and Early Intervention (for helping professions and high risk groups) Mental Health Awareness for Law Enforcement Mental Health Awareness in the LGBTQ+ Community NAMI Delaware’s Compartiendo Esperanza – Mental Health Awareness in the Latinx Community, offered in Spanish or English
Please select: NAMI In Our Own Voice – presentation by peers with lived experience NAMI Family and Friends – presentation by family members with lived experience NAMI Ending the Silence – for youth, includes young adult with lived experience
If you are human, leave this field blank.
