Program Request Form - Schools/ Colleges
Name/ Title *
Your answer
School Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Ideal date(s) for hosting program *
Your answer
Location: where will the program be held?(please include details on parking, bldg/ room numbers, security protocols, etc) *
Your answer
Which program are you requesting? *
Required
How many attendees do you anticipate? *
Approximately how long is each class/ session time? *
Are there any special needs or accommodations we should be aware of?
Your answer
Have there been any conditions or recent incidents we should be aware of? (If so please describe)
Your answer
Materials you can provide: (We can also bring, if needed)
Day-of Contact Info (if different from above)
Your answer
What else do you feel we should know to help make this program as effective and impactful as possible?
Your answer
The estimated cost per program is $250, but Our VOICE tries to provide free or sliding scale access to make our community safer. Are you in a position to offer a donation at this time?
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