Prevent Suicide PA Volunteer Form

Prevent Suicide PA Volunteer Form
Prevent Suicide PA invites you to join our efforts to prevent suicide by becoming a contributing volunteer of our organization.

Suicide prevention work groups have developed suicide prevention plans in their organizations, and schools, planned conferences, and held awareness and fundraising events over the past several years. It is the goal of the Prevent Suicide PA Board of Directors to develop a stronger presence statewide, but we need your help. We seek to develop a pool of volunteer representatives to participate and/or host regional efforts.This statewide infusion of a core mission and goals must start from a strong volunteer base. The combined efforts of many individuals can make a difference in the prevention of suicide attempts and deaths, and support the survivors of those lost to suicide.To this end, we are seeking individuals interested in participating in future events, getting involved in subcommittees working on implementing the state suicide prevention plan, assisting with fundraising efforts, or contributing in any other capacity. Please increase the impact of Prevent Suicide PA today by becoming a contributing volunteer. Complete the following membership application.
Name*

First NameLast Name
Agency/Organization*
County*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Email*
example@example.com
Interested in:*

AdultOlder AdultYouthPresentationsLaw EnforcementCorrectionsGLBTQ IssuesCorrectionsTrainingsVeteranSuicide Attempt SurvivorSurvivor of Suicide LossOther
Do you have an interest in serving on any of the following Prevent Suicide PA committees?*

Communication - working with the Board to facilitate timely and effective messaging around important events, helping to review and edit the website.Education- setting up trainings, reviewing training programs, being trained as a trainer in QPR(Question, Persuade, Refer), ASIST(Applied Suicide Intervention Skills Training), or MFHA(Mental Health First Aid)Fundraising – setting up fundraising events, talking to potential sponsors, identifying potential donors for the Board to approachPolicy and Legislation – working in collaboration with the Board and state and local politicians toward policy and legislation directed at suicide prevention
Do you already participate in a county suicide prevention task force?*

YesNo
If yes, please provide the Task Force Name:
Are you interested in being connected to your county suicide prevention task force, should one exist in your county?*

YesNo
PSPA may send emails requesting volunteers for specific events or activities throughout the year! Please make sure we have your correct contact information!
No one can do everything, but everyone can do something. And if everyone does something, then together we can change the world ~ Anonymous
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