TUPE Virtual Presentations Request
To ensure we understand your district/school needs, please complete this form when requesting the Santa Clara County Office of Education (SCCOE) Tobacco Use Prevention Education (TUPE) Services. If you would like assistance completing this form, please contact Anh Dao at
The SCCOE TUPE staff offers general education/awareness on vapes, nicotine, tobacco, and marijuana, in English or Spanish. Virtual Presentations will be conducted via Zoom.
Instructions: * A new form must be completed for each presentation requested.*
Answer the items below, to the best of your ability.
The contact person noted will be notified via email indicating the status of the request within approximately one (1) week. A TUPE representative will reach out for Presentation Dates/Times.
Please be advised all requests will be fulfilled based upon the SCCOE TUPE Personnel availability.
Thanks, in advance, for taking the time to provide this necessary information.
~ The TUPE Staff
District and School Name
Contact Person Email
Contact Person Phone Number (1-555-555-2121)
Please indicate the Target Audience (ex: Certificated, Classified, Students, Parents, Grade Level, etc).
Would you like the presentation to be conducted in Spanish?
Send me a copy of my responses.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of Santa Clara County Office of Education.