PACKtivist Application
Thank you for your interest in being a PACKtivist! Our goal with the PACKtivist Peer Program is to give students a chance to get involved on campus in supporting survivors and preventing sexual assault, dating/domestic violence, and stalking through outreach, education, and awareness.

If you have any questions, please email

Sign in to Google to save your progress. Learn more
Email *
Name (first & last)
Preferred Pronouns
Briefly describe why you would like to be a PACKtivist
Phone number
If you have a Facebook please provide a link to your profile
We have a Facebook group for PACKtivists! Please request to join the Group, here's a link:
Emergency Contact Name
Emergency Contact Phone Number
Academic Status
Clear selection
Languages Spoken
We will have regular meetings (times depend on schedules of those who join) you will be expected to attend. Are you willing to commit your time to be involved?
Clear selection
What days of the week do you have availability for meetings?
The PACKtivists will be broken up into smaller groups based on area if interest. Please check the box of the group you're MOST interested in (this doesn't mean you can't participate in other groups, but we'd like everyone to be involved in initiatives they're most passionate about).
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy