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Someplace Safe Education Request Form
What is the name and contact information for the Individual or Organization making the request?
Please share your NAME / ORGANIZATION / PHONE # / ADDRESS / EMAIL ADDRESS
Who is the audience for this request?
Special Interest Group
Would you like information from a specific Someplace Safe program?
Safe Harbor/Human Trafficking Programming
Parenting Time Centers
What topic(s) would you like covered?
Someplace Safe Overview
Parenting Time Center Overview
The Impact of Intimate Partner Violence on Children
Domestic Violence 101
Sexual Violence 101
Sexual Exploitation 101
Human Trafficking (Sex and/or Labor) 101
Community Safety Panel
Body Safety – (Grades Pre-K-3)
Online Safety/Digital Citizenship (Grades K-12)
loveisrespect (Grades 7-12) – Middle School and High School
Not a #Number (Grades 6-12) – Middle School and High School
Green Dot (college campuses)
How many attendees do you anticipate?
When would you like this Presentation to take place?
Request must be made AT LEAST 2 weeks ahead of time whenever possible
How long would you like this Presentation to be?
Where would this Presentation take place?
Please share the specific LOCATION and ADDRESS, including city, state and zip code.
Are you able to provide any financial contribution in exchange for this Presentation?
Someplace Safe is a nonprofit providing services to victims and survivors of crime free of charge. We ask that you provide a small contribution if you are able to do so.
If YES, where should the invoice be sent?
Party responsible for the payment - Please include FULL NAME & ADDRESS information
Are you able to provide any in-kind donation(s) or contribution in exchange for this Presentation?
Someplace Safe provides needed items for victims and survivors of crime in emergency situations.
Personal Care Items
Trac Phones/T-Mobile phones/cards
Gift Cards for local stores
Please note any additional questions, special requests, or information here.
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