Sexual and Relationship Violence Prevention Education Request Form

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

Education requested by:

Name

Group/Department

Phone

Group

If “academic class” is selected, what class?

If “residence hall” is selected, which residence hall?

If “greek organization” is selected, which chapter?

If “student organization” is selected, what student organization

If “sports club” is selected, what sports club/team?

If “athletic group” is selected, what group/team?

If “department” is selected, what department?

If “other” is selected, please specify:

Help us understand what you are hoping to learn from this education so we can best prepare. What sparked your interest in such education?

How can we assist you?

Presentation/workshop

Preferred date

Start Time

End Time

Second preferred date

Start time

End Time

Campus

Would you like SRVP to participate in-person or virtually?

In-person participation details

Building name

Room number

Instructions for finding location

Virtual participation details

Zoom link

Zoom password/code (if applicable)

Number of attendees

What education are you interested in?

Equipment available for presenters

other equipment available

Interactive information table

Name of event/program

Brief description of event/program

Date

When can SRVP begin setting up?

When should SRVP begin tabling?

When should SRVP end their tabling?

When should SRVP’s table be cleaned up?

Campus

Would you like SRVP to participate in-person or virtually?

In-person participation details

Building/location name

Room number (if applicable)

Instructions for finding location

Virtual participation details

Zoom link

Zoom password/code (if applicable)

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

If “other” is selected, please expand upon this:

Brief Informational Visit

Name of class/meeting

Brief description of class/meeting and the audience

Date

When would you like SRVP to stop by?

When should SRVP leave?

Campus

Would you like SRVP to participate in-person or virtually?

In-person participation details

Building/location name

Room number

Instructions for finding location

Virtual participation details

Zoom link

Zoom password/code (if applicable)