Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Center for Community Solutions workshop request
If you have additional questions or inquiries please email
prevention@ccssd.org
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Workshop(s) you are requesting
*
CCS 101
Healthy Relationships multi-unit series (Healthy Relationships, Consent, Social Norms, Bystander Intervention)
Healthy vs Unhealthy Relationships
Consent & Boundaries
Understanding Social Norms
Bystander Intervention
Dynamics of Intimate Partner Violence
Overview of Sexual Assault and Consent
Healthy Parent/Guardian-Child Relationships
Teen Culture
Keeping Children Safe from Abuse
Technology-based Abuse
Community Resiliency Model (CRM)©
Crisis Intervention Training (CIT)
Other:
Required
Date of requested presentation
*
MM
/
DD
/
YYYY
Approximate Time of requested presentation
*
Time
:
AM
PM
Any additional date/time information?
*
Your answer
Group size
*
1-9 people
10-19 people
20+ people
Other:
Audience
*
Students- high school
Students- middle school
Students- college
Parents, guardians, & caregivers
School administrators
Community partners
Train-the-trainer
Professional development
Other:
Required
Location and Address of where the event will be hosted
*
Your answer
Any additional comments/questions?
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report