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Orange Button Suicide Prevention scheme application form
All items marked
*
are required
Step 1
Step 2
Section 1 of 2 - Step 1
Step 1
Your name
*
:
Your address
*
:
Maximum length 300 characters
A
Your email address
*
:
Which training have you completed? (Please select only one)
*
:
Suicide Awareness & Prevention training (delivered by North Staffs MIND)
Full 2 day Mental Health First Aid
Suicide Prevention First Aid
ASSIST
Other
Other - please specify
Proof of training
If you selected anything other than Suicide Awareness & Prevention Training (North Staffs MIND), please email proof of attendance to
suicideprevention@staffordshire.gov.uk
.
Date training completed (Your training must have been completed within the last 12 months)
*
:
Please leave this text box blank
*
:
