#iCANEndTheTrend: E-cigarette/Juul Prevention & Empowerment Program Interest Form
As we see a surge in Juul and other tobacco product use among our youth and young adults, there is a need to promote awareness and empower them to advocate for change among their peers and in their schools and communities. We are using a peer-to-peer model to help educate and create impetus for change among our youth and young adults. Please complete the following form if you are interested in a program for your school and/or group. We will reply to your request as soon as possible to confirm a date, time, and/or discuss additional details.
Population Served (select all that apply)
Middle School Students
High School Students
High School Athletes
Undergraduate College Students
Graduate College Students
Number of sessions requested (sessions typically range from 45-60 minutes)
More than 4
One student group (i.e., one class)
Multiple student groups (i.e., more than one class)
Large student group
Please describe the target population.
Estimated number of participants
Please indicate days/times that work for your group. If none, please indicate other and we will contact you to set something up .
Will we have access to any of the following?
Please indicate any other information that will help us fulfill your request.
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of University of Kentucky.