Program Request Form - Schools & Colleges (COVID19)
For the time being, Our VOICE will not be doing in-person programming in an effort to prevent the spread of COVID19; however, we remain committed to serving our communities through modified prevention education. We are working hard to transform our programs to the best of our ability, and we understand that everyone is doing their best to navigate new ways of being. We appreciate your patience and grace as we work through this together. Our VOICE school programs are designed for 6th-12th grade and college-aged students. We provide programs free of charge to public schools and request $300 for all other institutions, on a sliding scale. Please contact Julia at to discuss discounted rates if this price is beyond your budget. We strongly believe financial challenges should not restrict anyone’s access to these programs. Please visit our website for more information:
Email *
Name / Title *
School Name *
Phone Number *
Ideal date(s) for hosting program *
Ideal time(s) for program to start *
Age range of program participants *
Which program are you requesting? *
Do you have the ability to participate via virtual video conferencing platform such as Zoom, Google Hangouts, etc.? [We have access to video conferencing software. All program participants just need to have internet access and a smart device (phone, computer, tablet, etc.) with a camera/microphone to participate.] *
How many participants do you anticipate? **Please note there is a 30 participant maximum for each session** *
How much time are you able to set aside for a session? *
Are there any access needs or accommodations we should be aware of? (language interpretation, captions, ASL, etc.) *
Have there been any conditions or recent incidents we should be aware of? If so, please describe. (For confidentiality reasons, please do not include any personally identifying information about folks involved. As mandatory reporters, we are required to report any disclosure of violence or abuse happening to youth.)
Can you provide any of the following?
Do you have time available for a follow-up phone call after completing this form to talk through scheduling and how to prepare for the session? If so, please list some possible days/times. *
Day-of Contact Info (if different from above)
What else do you feel we should know to help make this program as effective and impactful as possible?
We're happy to answer any questions, please contact Julia at Thank you!
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