Sexual and Relationship Violence Prevention Education Request Form

Thank you for requesting education from the ASU Sexual and Relationship Violence Prevention Program. Please complete this form at least two weeks prior to the planned program date and provide as much information as possible.

How can we assist you?

Select an option to continue

Presentation

Preferred date:

Start time:

End time:

Presentation

Second preferred date:

Start time:

End time:

Campus:

Building name:

Room number:

Instructions for finding location:

Number of attendees:

Group:

If other, please specify:

What do you wish to offer the group?

Sun Devil Support Network (6 hours on one day)

Sexual Violence Prevention Leadership Program (6 1-hour sessions for six weeks)

One-Time Presentation

Which presentation would you like?

If other, please specify:

Equipment available for presenters:

Computer projector

Computer

Overhead projector

TV/DVD

Tables

Chairs

Tent/Shade (if outside)

Stage (if applicable)

Other equipment available

If other, please specify:

Information table

Date:

Set up time:

Event start time:

Event end time:

Campus:

Location:

Specific directions to finding location:

What topic would you like us to plan our activity around?

Do you prefer a student peer educator or ASU staff health educator?

Program consultation

Name of group coordinating event:

Proposed topic:

Do you have a date?

Please provide as much information as possible about the type of education or event you are planning or hoping to plan.

Your information

Education requested by:

Name:

Group/department:

Email:

Phone:

Miscellaneous:

Additional information you would like to share with us about the program:

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