Presentation Request Form
TEEN ALERT PROGRAM (TAP808)
Contact Information
Name
*
First Name
Last Name
Job Title
School, Agency, or Company
*
Email
*
example@example.com
Contact Number
*
Are you requesting on behalf of additional teachers/staff?
*
Yes
No
Please list the names and contact info of additional staff included in this request
Request Information
Place of presentation?
*
Virtual
In-Person
Address:
*
If virtual, which platform?
Zoom
Google Meet
Other
Type of Training
*
TDV 101: Intro to Abuse & Healthy Relationships
Training for Staff or Service Providers
Teen Dating Violence 101 for Parents, Guardians, Caregivers
Other
Training structure requested
*
1 day training
2 day training
If requesting more than 2 days, TAP808 will reach out to do our best to accommodate you!
Preferred Dates
Presentation length
*
1 Hour
75 Minutes
90 Minutes
2 Hours
Other
Class Times and room number (if in person): (You may also email a schedule to teen@stoptheviolence.org)
*
If scheduling presentations for a full day, please be mindful to allow time for TAP808 presenters to use the restroom and eat lunch. If requesting a full day of back to back presentations, please indicate the need for 2 presenters in the "additional information" section below.
Total number of participants. Please note, the minimum number of participants is 5.
Grade(s) of Students
*
6
7
8
9
10
11
12
College
Other
Class or Group Subject
*
Any additional information or questions
Logistics Information
Equipment available on-site:
*
Speakers
Projector or TV
Power Outlet
Access to wifi
None of the Above
Is parking available? If so, where should TAP808 staff park?
*
Where should TAP808 staff check-in?
*
Confirm your understanding that a member of your school/agency staff must remain in the room during TAP808 sessions at all times due to the potential for an emergency such as a fire or school lock-down procedure.
*
I understand and at least one member of my school/agency/organization staff will remain in the presentation at all times.
I am requesting a virtual presentation.
Submit
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