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2. Question Persuade Refer (QPR) is an evidence-based suicide prevention training offered by certified trainers in a 60- 90 minute session. Session size needs to be limited to groups of 35. Groups larger than 35 should request multiple sessions. 
   Please allow up to 4 weeks for scheduling. 

4. Number of participants to be trained:*
5. Name or description of group or organization:*
6. Number of sessions requested:*
8. Please indicate what equipment is available at this location (choices with an * are required):*

   1. Internet*
   2. Computer or laptop
   3. Large screen (projection, television, or digital board)*

   1. Presentation pointer
   2. Chairs to accommodate group*
   3. Tables to accommodate group
9. Indicate some potential dates/times for this training:*

   Please schedule 4 weeks in advance. Plan for a 90 minute session. Trainers will arrive 30 minutes before session start to set-up. If you do not have specific dates chosen at this time, estimate the month and which days/times of day are best.

11. Requestor's Name:*
12. Email:*
13. Phone:*
15. Training site name:*
17. Address*
19. How did you hear about this training?*

    1. Facebook
    2. Press release
    3. Flyer
    4. Walworth County website

    1. School staff
    2. Friend
    3. Employer
    4. Other (please explain->)
20. If other, please explain:

22. Thank you for your request. 

    A staff member will respond within 3 business days. If you have questions, please contact: walcoph@co.walworth.wi.us or 262-741-3200.

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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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