QPR (Question, Persuade, Refer) – Virtual, Live (MC)

First Name *

Last Name *

What are your pronouns? * She/Her/Hers
He/Him/His
They/Them/Theirs
Other

Email *

Would you like to be added to our mailing list about upcoming trainings and events? * Yes
No

Phone *

Get Trained to Help is supported by Clackamas, Multnomah and Washington Counties and we gladly serve people who live and/or work in these counties and who are 18 years or older.

We ask questions about the county and zip code where you live and work to improve our outreach to all parts of the tri-county area.

What county do you work in? * Clackamas
Multnomah
Washington
Other County
I don't have a work address

What county do you live in? * Clackamas
Multnomah
Washington
Other County
I don't have a home address

Do you need any of the following accommodations to participate in this training? * Language interpreter or translation services
Assistive reading materials / Braille
Assistive listening devices / closed captions
Wheelchair access
An assistant or service animal to accompany me
I don't need any accommodations

What is your employer organization or agency? *

What is your job title? *

How did you hear about Get Trained to Help? * Email or listserv
Employer Required
Family/Friend Referral
Professional or Workplace Referral
News Story/Advertisement
Web Search

Are you 18 years of age or older? Yes
No

What is your age? * <18 years
18-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75+ years

What is your gender? * Woman
Man
Non-binary
Feminine-leaning
Masculine-leaning
Questioning
Don't know
Don't want to answer
Not listed

Which of the following describes your racial or ethnic identity (Select all that apply) * Hispanic and Latino/a/x/e
Native Hawaiian and Pacific Islander
White
American Indian and Alaska Native
Black and African American
Middle Eastern/North African
Asian
Don't know
Don't want to answer
Not listed

I consent to my submitted data being collected and stored as outlined by the site Privacy Policy.