VAWPP Workshop Request Form Name* First Last What group/class are you making this request for?* Contact phone*Contact email* Enter Email Confirm Email Please indicate the workshop you are requesting* Power and Relationships Gender and Violence in the Media* Sexual Consent Bringing in the Bystander * *This workshop includes use of a video, so access to a DVD player or computer and projector is required. It is your responsibility to provide the necessary audio/visual equipment for this program. First preferred date of program* MM slash DD slash YYYY Second preferred date of program* MM slash DD slash YYYY First preferred time of program* : Hours Minutes AM PM AM/PM Second preferred time of program* : Hours Minutes AM PM AM/PM Location of program* Expected attendence (Minimum attendance: 10 participants)* Important Information* I acknowledge I have read the following information: · Requests must be made at least two weeks in advance (e.g. a workshop request for March 14 must be submitted by March 1). · Cancellation of a workshop must be done at least two days ahead of the scheduled time. To cancel a workshop, please email the VAWPP Coordinator at lauren.donais@uconn.edu directly. · There is a minimum workshop attendance of ten participants. · The workshop is not confirmed once a request is made. Someone from the program will send a confirmation email once facilitators are scheduled. · In the even that none of our peer educators are available during the time requested, Women's Center professional staff will fill in.PhoneThis field is for validation purposes and should be left unchanged.