WEAVE Presentation Request Form Post July 25, 2017 Date of Presentation: * Please provide specific date if known, or proposal of different dates that may work. Location of Presentation: * Provide address and specific room if possible. Length of Presentation: * 1 Hour 1.5 Hours Not Sure Other If Other: Please list the desired length of presentation. Time of Presentation: * Please list different time options if known. Presentation Topic: * Domestic Violence Teen Dating Violence Healthy vs. Unhealthy Relationships Sexual Assault & Consent Sex Trafficking Gender Socialization Bystander Intervention Silence Doesn't Work Here (for workplace settings) WEAVE Services Safe Night Out Pride, Pronouns & Progress Will a laptop and/or projector be provided?: * Yes No I will find out Who is the presentation for?: * Examples: High school freshman, pre-med students, volunteers, faith-based organization staff, etc. Point of Contact: * Name: Email: Phone Number: Please provide both email and phone number. Accommodations : Any accommodations needed for the presentation (large print handouts, no fragrances, ASL interpretation, etc.) Additional Information: Is there anything else you would like WEAVE to be aware of?