First Name Last Name Email Phone Number Presentation Organization/Institution Name Organization Type K-8 High School College/University Professional/Corporation Foundation Nonprofit/NGO Government/Military Healthcare or Treatment Center School System/ District Chapter Format of EventPlease select... Virtual Event In-Person Event Type of EventPlease select... Speaker Story, Keynote, or Workshop V-A-R: Validate, Appreciate, Refer Training QPR: Question, Persuade, Refer Suicide Prevention Training Mental Health In The Workplace (Active Minds @Work) Training Other Type of Event (Other) Approximate Number of Attendees Please use whole numbers Engagement Assessment What is your overall assessment of the event?Please select... Outstanding Very Good Good Acceptable Unacceptable Did you meet or speak to anyone representing an Active Minds Chapter?Please select... Yes No N/A If yes, did anyone stand out to you as exceptionally passionate about Active Minds?Please select... Yes No N/A Please elaborate. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree The Active Minds staff provided timely and accurate pre-event information regarding planning and logistics I felt prepared for the event What additional training or support could have better prepared you for this event? Please elaborate. Strongly Agree Somewhat Agree Somewhat Disagree Strongly Disagree The host organization was professional to work with What would you say could have improved the event? Pay It Forward Did you participate in Pay it Forward?Please select... Yes No If you attended, what is your overall assessment of the Pay it Forward event?Please select... Outstanding Very Good Good Acceptable Unacceptable What would you say could have improved the Pay it Forward event? Contact Information
