Startup Questionnaire This Startup Questionnaire will help our team to better understand your current prevention efforts and the scope of your interest in Sources of Strength. Please fill out this questionnaire and someone from our team will reach out to schedule a conversation about bringing Sources to your community. Step 1 of 5 20% Contact DetailsName* First Last Email* Enter Email Confirm Email Phone*Phone ExtensionOrganization*Job Title*Address*Associated with your Organization Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Potential ImplementationRegion*In what targeted region, area, or school system do you wish to implement Sources of Strength?Number of Peer Teams*Approximately how many peer teams do you wish to include in your start-up effort. Potential Teams*Please provide information about any and all Peer Teams you hope to train, the size of school/group and demographics. Include Middle Schools, High Schools, Colleges, Community Groups, Faith-Based, Other. This is intended as a planning tool and not a final decision. Details for Existing EffortsExisting Programs*Sources of Strength is intended to support, not replace existing programs. What peer leader efforts already exist in your targeted schools or groups?Previous/ Existing Prevention Efforts*Sources of Strength works in partnership with many other programs and is designed to strengthen and support existing efforts. What suicide prevention or other prevention efforts have already been implemented in your targeted area? Prevention Activities*Which of the following descriptions would best describe the current prevention activities in your targeted areas? Very little prevention activity.Crisis driven but stops soon after the crisis is over.Most activity is one time speakers, assemblies, etc...Some ongoing efforts, mostly education, gatekeeper, etc...Several prevention efforts are active and ongoing.Many efforts are ongoing and have been sustained for 5 years or more. Details for ImplementationFunding*Do you presently have funding for the Sources of Strength program? If so, what amount have you designated for the first year start-up?Please enter a value between 0 and 100000.Support*Please describe the present level of awareness and buy-in of key stakeholders, administrators, or area coalitions for Sources of Strength.Evaluation*Please describe any evaluation plans you presently have for your project or any evaluation needs you may have.Timeline*What is the estimated timeline in which you hope to implement Sources of Strength? How did you discover Sources of Strength?*WebinarConferenceNREPP RegistryGoogle AdWord of MouthNPR ArticleJournal ArticleOtherPlease describeEmailThis field is for validation purposes and should be left unchanged.