TAP808 Presentation Request Form

Presentation Request Form

TEEN ALERT PROGRAM (TAP808)
Contact Information
Name*

First NameLast Name
Job Title
School, Agency, or Company*
Email*
example@example.com
Contact Number*
Are you requesting on behalf of additional teachers/staff?*

YesNo
Please list the names and contact info of additional staff included in this request
Request Information
Please visit TAP808 for program descriptions, terms, and conditions.
Place of presentation?*

VirtualIn-Person
If virtual, which platform?

ZoomGoogle MeetOther
Type of Training*

TDV 101: Intro to Abuse & Healthy RelationshipsSingle Gender GroupsTalkStory Session (specify topic in "Other")Lunch RalliesTraining for Staff or Service ProvidersTeen Dating Violence 101 for Parents, Guardians, CaregiversOther
Training structure requested*

1 day training2 day training3 or more
Preferred Dates
Presentation length

1 Hour75 Minutes90 Minutes2 HoursOther
Class Times and room number (if in person): *
Total number of participants. Please note, the minimum number of participants is 5.
Grade of students
Any additional information or questions
Logistical Information
Equipment available on-site:*

Laptop/PCApple/MacbookSpeakersProjectorWhiteboard/NewsprintNone of the Above
Please list any parking or other relevant information for presenters:
Should be Empty:

Presentation Request Form