Healthy Reality - Program Registration
Healthy Reality is a program that is a continuation of the Reality Check program - in that it is a peer lead curriculum - but it focuses on healthy relationships, sexual violence and consent. This program is meant to be taught by upperclassmen with the assistance of a guidance counselor to junior high students.

In order to participate in this program, please fill out this quick survey so that Northern Lights Youth Services can track progress and use this research to advance the organization's future funding opportunities. Your first and last name nor E-mail address WILL NOT be given out. If you are doing this program with your chapter/with a group, only have one individual submit the program registration - they will act as the primary contact.

Thank you!

State
City
Your answer
School
Your answer
How many members of your group/chapter will be participating?
Your answer
What is the time frame of this program? (i.e. all lessons will occur from February to April)
Your answer
How many students will be taught this curriculum?
Your answer
Contact Person's Name
Your answer
Contact Person's E-mail Address
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of NLSADD. Report Abuse - Terms of Service - Additional Terms