Superstar Health Education Workshop Request Form
Name of School or Organization *
School or Organization Address
School or Organization Phone Number *
Contact Person *
Contact Person's Title
Contact Person's Phone *
Contact Person's Email *
School Phone number *
Grades Needing Workshops
Number of Classes in Each Grade
Number of Students in Each Class
First Choice for Dates (please list the Monday date of the week of programing) *
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DD
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Second Choice for Dates *
MM
/
DD
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YYYY
Third Choice for Dates *
MM
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DD
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YYYY
What are the best class times for your school's schedule? Each class needs 1 hour each day for 4 days in a row. (10 min. in between is helpful) Example: for a school with 4 groups of students.. 9am, 10:10, 11:30 and 1pm. If you are not sure yet of the schedule who is the best contact person for schedule planning?
Would you like a parent education program? If YES- What are the languages do your parents speak? Will they need translations?
1st Choice Date/Time Parent Ed (1hr workshop)
2nd Choice Date/Time Parent Ed (1hr workshop)
3rd Choice Date/Time Parent Ed (1hr workshop)
Contract & Payment
Different schools have different contracting and payment solutions. Please let us know your needs regarding contracts and payment.
What kind of contract will you require? *
How will you pay? *
School Data
To better serve your school we like to see your socio-economic data. Many schools have Accountability Report Cards online. If you do, please link to that report below. For SFUSD, your reports can be found here: www.sfusd.edu/en/schools/all-schools.html

If you don't have an online report card: please give us a summary of demographics (ethnicity, lunch subsidies, disabilities, ) and tuition costs (for private schools).
School Accountability Report Card Link
(IF NO ONLINE REPORT) Summary of demographics
Additional Comments or Requests
We look forward to serving your school!
We're committed to medically accurate, age-appropriate, shame-free, comprehensive sexuality education. Grounded in our anti-oppression philosophy, our work encourages people to make informed decisions about caring for their bodies and being sexually healthy.
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