RAVE & Family Teen Program Signup Form

1. Program Choice
2. RAVE Family Teen Program
3. First Name*
4. Last Name*
5. Address of Location*
6. City*
7. State*
8. Zip Code*
9. Email*
10. Phone*
11. Requesting School or Organization
12. Approximate number of participants
13. Audience
14. School Target
15. Middle School (6-8) High School (9-12)

Please check your preferred topics to create a 3, 5, or 8 unit package:

1. Unit 1: Defining Caring Relationships (Mandatory)
2. Unit 2: Defining Dating Abuse
3. Unit 3: Why Do People Abuse?
4. Unit 4: How to Help Friends
5. Unit 5: Media's Impact on Gender Stereotyping
6. Unit 6: Sexual Harassment
7. Unit 7: Sexual Assualt
8. Unit 8: Communication: How We Feel/How We Deal
9. Unit 9: Digital Drama

1. Preferred dates of presentations
2. Preferred start time

Check if your agency has the capacity to view:

1. PowerPoint Presentation
2. VHS
3. DVD

1. Special Requests
5. Please enter the letters/numbers shown.

 

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