Education and Training Request Form
General Info
Primary Contact
*
First Name
Last Name
Primary Contact Email
*
example@example.com
Primary Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is this phone text-friendly?
*
Yes
No
Organization
What kind of training or education event do you want?
*
Please Select
A school-based lesson for grades K-12
A higher-ed training for RAs
An adult-level lesson for a workplace, organization, etc.
Tabling at a community event
Establishing a regular drop-in for youth
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School-Based Education
Where is your school located?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
For what grades are you requesting education?
K-3rd
4th-6th
7th-8th
9th-12th
What lesson(s) are you interested in? Select all that apply.
(K-3) Balancing wants and needs for yourself and others
(K-3) Using your voice to stand up for yourself and others
(4-6) Healthy and unhealthy relationships within family and friend groups
(7-8) Healthy and unhealthy relationships within the dating world
(9-12) Dating abuse and violence overview
(9-12) How power and control can shape relationships
Roughly how many students would participate (an estimate to the nearest 5 is fine)?
How many teachers will be on hand to help facilitate?
What are your top three date/time options for this school visit?
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Higher Ed: Training for RAs
What is the address of where this training would take place?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Roughly how many students would participate?
Would there be any staff available to help facilitate? If so, how many?
What are your top three date/time options for this RA training?
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Adult-Level Workplace/Agency Trainings
What training(s) are you interested in? Select all that apply.
Domestic Violence 101
Human Trafficking 101
Domestic Violence in the Workplace
Post-separation Abuse
Elder Abuse
Other
Can you host this training, or would you be hosting it in the Safe Voices Training Center in Lewiston?
Please Select
Host at our own workplace/agency space
Host at Safe Voices
Where would this training take place?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many participants do you expect?
Are there any special circumstances, considerations, or custom training needs you want us to be aware of?
What are your top three date/time options for this training?
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Community Event Tabling Request/Invite
What is the date of your event?
-
Month
-
Day
Year
Date
What is the start & end time?
Is there a cost for tabling? (Note: It is rare that we can attend a tabling event that requires tablers to pay for space)
Please Select
Yes
No
Do you provide any of the following items? Please check all that apply.
Table
Chair(s)
Access to electricity
Tent
Water
Other
Is there anything else we should know about the event?
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Request to Establish a Regular Drop-In
Where would the drop-in sessions take place?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the age range you expect to utilize this drop-in?
Middle school
High school
Other
How many people do you expect might cycle through the drop-in space during a session?
Is there anything else we should know?
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Please click submit
Submit
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