Risk Reduction Resource Kit Request Form
If your site qualifies to receive a Resource Kit, you will be placed on our waitlist and a HIFY Health Educator/Trainer will reach out to you as soon as your kit is ready to be delivered to your site
Name of Organization, Agency, or School *
Your answer
Name of Point Person *
Your answer
Position Title of Point Person *
Your answer
Phone Number of Point Person *
Your answer
Email of Point Person *
Your answer
How did you hear about our kits? *
Your answer
Address of the location to which the RRRK should be delivered *
Your answer
Number of Youth who use/pass through your space monthly? *
Your answer
What ages or grade levels does your site support? *
Your answer
How would this kit support your youth? *
Your answer
Where at your site would this Resource Kit be located? *
Your answer
What are the factors contributing to the need for this material? In other words, why are these resources not already present in the space? *
Required
Do you need everything that is included in the RRRK? *
If NOT, please let us know what you DON'T need
Your answer
Comments or Questions
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms