Project Wake Up Interest Form

What is your Title/role at your organization?

Organization/school name (No abbreviations ex: University of California, Los Angeles not "UCLA")

Organization Type

How did you hear about Active Minds?

Estimated number of film screening attendees?

Virtual or in Person?

VirtualIn-person

Are you interested in adding on a Q&A after the film with the Project Wake Up team?

How did you hear about Wake Up: Stories from the Frontlines of Suicide Prevention?

Do you have any questions?

I understand that this product is not recommended to anyone under 18

K-8 Students	High School Students
College/University Students	Faculty, Staff, Administrators, Educators
Managers/Employees	Professionals
Community Members	Healthcare workers
Parents/Caregivers	Veterans/Active Duty Service Members
Other

Project Wake Up Q&A Interest Form