a Community Collaboration to Reduce the Incidence and Impact of - PDF document

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G G a a t t e e w w a a y y Y Y o o u u t t h h S S u u i i c c i i d d e e P P r r e e v v e e n n t t i i o o n n R R e e s s o o u u r r c c e e s s P P a a r r t t n n e e r r s s h h i i p p a Community Collaboration to Reduce the Incidence and Impact of Suicide in the Eastern Region of Missouri c/o KUTO 2718 S. Brentwood Blvd. St. Louis, MO 63144 314.963.7571 T T r r a a i i n n i i n n g g O O p p p p o o r r t t u u n n i i t t y y A A S S I I S S T T ~ ~ A A p p p p l l i i e e d d S S u u i i c c i i d d e e I I n n t t e e r r v v e e n n t t i i o o n n S S k k i i l l l l s s T T r r a a i i n n i i n n g g a two day workshop for community caregivers & gatekeepers a ttendance required on both days for Certificate of Completion  April 30 & May 1 , 2014 at Behavior al Health R esponse; 12647 Olive Street, STL , MO 63141 both days begin at 8:45a & end at 4:45p ASIST is a practical, skill based and helping strategy model to identify the immediate risk of suicide & link people to help . Learn How To:  Recognize opportunities for helping  Reach out & offer support  Assess the risk of suicide  Apply an intervention model  Link people with community resources S S p p a a c c e e i i s s L L i i m m i i t t e e d d ~ ~ R R e e g g i i s s t t r r a a t t i i o o n n I I n n f f o o r r m m a a t t i i o o n n A A t t t t a a c c h h e e d d Special Offer ~ $ $ 5 5 9 9 p p e e r r p p e e r r s s o o n n * * for agencies &/or residents of St. Louis City and St. Louis, St. Charles, Fra nklin, Jefferson, Lincoln, and Warren counties. All Other Attendees ~ $ $ 1 1 5 5 9 9 p p e e r r p p e e r r s s o o n n * * Includes: t raining materials, lunches, snacks & beverages both days. For Questions or Information contact Elizabeth Makulec 314.963.7571 or programs@KUTO.org Workshop Reservations WILL NOT be held without receipt of both Registration Form & Fee This workshop is underwritten by the Gateway Youth Suicide Prevention Resources Partnership i

2 n collaboration with the Missouri De
n collaboration with the Missouri Departme nt of Mental Health * LivingWorks values this training at $275 per person . Retain this page for your records PLEASE RETURN THIS PAGE with Reservation Fee ASIST ~ Applied Suicide Intervention Skills Training Please check the Training dates you are registe ring for:  April 30 & May 1, 2014 Reservation Deadline: April 21, 2014 at Behavioral Health Response; 12647 Olive Street, STL, MO 63141 Name: ___________________________________ ___ ______________ ___ ____ _____________ Please Print Legi bly Agency/Organization: __________________________ ___ ______________ __ __ ____ _________ Address: _______________________________________ ____ ____________ __ ____ ____ _____ City: _______________________________ State: ___ ___ __ _ _ ZIP: _ _ ___ _____ _ ________ Em ail: ________________________________________________ _____ _____ ___ ___ __ ______ Work Phone:_________________________ Cell/Mobile Phone: ______________ _____ _ _ _____ Name on Name Tag: __ ____ _____________________________________ ________ _____ _ ____ Name you’d lik e on your ASIST Certificate: _______________________________ _ _ _______ ___ Dietary considerations: ___________________________________________________ _______ _ Primary population you work with: [ ] Children [ ] Adolescent [ ] Adult [ ] Elderly [ ] All Ages [ ] Other , (please explain) _________________________________________________________ _______ _ [ ] Special Reservation Fee: $5 9 by [ ] Check [ ] Money Order [ ] Purchase Order [ ] All Other Atte ndee Reservation Fee : $159 by [ ] Check [ ] Money Order [ ] Purchase Order Workshop Res ervations WILL NOT be held with out receipt of both Registration Form & Fee Return this Reservation Form with Reservation Fee: Please make Checks payable to KUTO KUTO 2718 S. Brentwood Blvd. St. Louis, MO 63144 Attn: ASIST Training Receipt of $5 9 or $159 Reservation Fee by Check, Money Order or Purchase Order assures attendance in the workshop