Certified LOSS Trainer/Consultant Application Form

I am interested in being considered for the National LOSS Team Trainer Certification Program! (Be sure to read through all the questions and required information before beginning the application process - you cannot save your progress in this online form!)

First name

Last name

Phone

Address

Country/Region

Address

Address - line 2

City

Zip / Postal code

Current Agency/Organization name

Current Position/Title

List completed Suicide Prevention Trainings (i.e., QPR, safeTalk)

List completed Suicide Intervention Trainings (i.e., Living Works ASIST, CAMS)

List completed Trauma Informed Training (i.e., NOVA Basic CRT, NCTSN's Psychological First Aid, Other Psychological First Aid)

List completed Grief Based Trauma Informed Training (i.e., Portland Institute Dr. Bob Neimeyer, Center for Loss & Life Transition Dr Alan Wolfelt)

Provide the name(s) and location(s) of the LOSS Team(s) you currently serve on or have served on in the past.

Approximate number of suicide scenes you have been on.

Approximate number of delayed responses you have physically attended (excludes phone calls).

Explain how you plan to apply the knowledge and experience gained through this certification to advance and strengthen the LOSS Team movement.

After reviewing the existing list and qualifications of Nat'l LOSS Team Trainers/Consultants, what unique value will you bring to the Nat'l Training Team?https://www.lossteam.com/trainers

I acknowledge that I have read the "Team Trainer Certification" document.

I understand that space within the Certified LOSS Team Trainer group is limited and that submitting this application does not guarantee acceptance into the certification process.

Recommendation Letter #1

Recommendation Letter #2

CV File upload