Education Request Form
Thank you so much for your dedication to ending sexual violence in our community. We value our community partners and look forward to working with you!

Community members from Cedar, Des Moines, Henry, Iowa, Johnson, Lee, Washington, and Van Buren counties, please use this form to request any presentations, trainings, or prevention programs from RVAP.

Please submit your request at least 2 weeks in advance of your preferred date(s).

If your organization is affiliated with the University of Iowa, please use the following link to the university's violence prevention program request form, https://uiowa.qualtrics.com/jfe/form/SV_79exi7qt1sKibQh

If you have questions before submitting your form, please contact Susan Junis by email at susan-junis@uiowa.edu or by calling (319) 335-6001.

Organization *
Your answer
Address *
Your answer
Contact Person *
Your answer
What is your role? *
Your answer
Phone number *
Your answer
email *
Your answer
How do you prefer to be contacted? *
Will your organization be providing a space for the presentation? *
What will RVAP need to provide for the presentation? *
Required
Which best describes your audience? *
Required
How long of a presentation are you looking for? *
Dates and Times requested (must provide 2 weeks notice) *
Your answer
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