VOICE Presentation Request Form
VOICE is Georgia Tech's sexual and relationship violence prevention and response initiative, and is based in the Office of Health Promotion.

To request a presentation facilitated by VOICE Peer Educators, please fill out the following form.

For more information about presentations, as well as other resources, visit http://healthpromotion.gatech.edu/voice.

What is your name?
Your answer
What is your email address?
Your answer
What is your Georgia Tech affiliation?
What group are you representing?
ex: Greek chapter, residence hall, other campus organization
Your answer
What is your preferred presentation date?
MM
/
DD
/
YYYY
What is your preferred presentation time?
Time
:
Please select an optional date in case the preferred date is unavailable.
MM
/
DD
/
YYYY
Please select your preference for presentation time on your optional date.
Time
:
Where will the presentation be?
We ask that you reserve a space for this presentation. The presentation requires a computer, projector, and A/V capability for playing a PowerPoint and videos.
Your answer
Please select your preferred presentation length:
What topic(s) would you like this presentation to focus on? Please select all that apply:
Required
Do you have a preferred VOICE Peer Educator(s) to facilitate this training?
Your answer
How did you hear about VOICE?
Do you have any other questions, comments, or context about your request that you would like us to know?
Your answer
If you were a fruit, what kind of fruit would you be?
Your answer
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