First Name
Last Name
Email
Phone
What is your Title/role at your organization?
Organization/school name (No abbreviations ex: University of California, Los Angeles not "UCLA")
Organization/School Street Address
Organization/School City
Organization/School State/Province
Organization/School Zip
Organization Type
Please select...
K - 8
High School
College/University
Professional/Corporation
Foundation
Nonprofit/NGO
Government/Military
Healthcare or treatment center
School System/District
How did you hear about Active Minds?
Estimated number of film screening attendees?
Target Audience (Check all that Apply)
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
Other
*We do not recommend the film for audiences 18 years old and younger. Please see our resources on K-12 work*
Virtual or in Person?
Virtual
In-person
if "in - person" is selected, then choose:
Please select...
Classroom
Auditorium
Theater
Other
Other
Are you interested in adding on a Q&A after the film with the Project Wake Up team?
Please select...
Yes
No
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
Contact Information