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  >> Survey Form >> Community >> ID #1777099  |   Show DetailsPrinter Friendly Page Tell A Friend
Youth Suicide Prevention Survey
Multi-purpose survey to join the Initiative or notify us you have found a member in need.
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This survey can be used for multiple reasons.

*Check* If you'd like to join the group that supports the Initiative and to receive email (when appropriate), click the first box.

*Check* If you've come across a member through a written item, forum post, bioblock, or any other aspect of their portfolio or profile that you feel is considering suicide that would benefit from the resources found on our suicide prevention page, place their username (not their handle) in the space provided.

*Note* This survey can be sent anonymously and multiple times. *Note*

"Youth Suicide Prevention Survey" Questions
Multiple submissions allowed / (R) denotes a required field.

You may submit your survey anonymously by checking the box to the left.

1.   I would like to join the supporter group for Youth Suicide Prevention Initiative.

      Check this box to agree with the above statement.

2.   I have found a member I believe may be contemplating suicide and/or self-injurious behavior and would benefit from being contacted by the Initiative. Please provide their username and a brief description of why you believe they are in danger. Include item number if it applies.

     

Disclaimer: The information that you are submitting with this survey form is being sent to Brooke - thanks her friends . It is NOT being sent to Writing.Com. You should be careful to not submit any information which you may deem as private or confidential. Writing.Com and its affiliates will not and may not be held responsible or liable, in any way, for any damages that may or may not arise from your submission of this form.

       

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