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Name of individual requesting a program:
Organization or group affiliation:
Which of our programs are you interested in receiving?
Bystander Intervention (1 Hour)
Healthy Relationships (1 Hour)
Sexuality 101 (1 Hour)
Green Dot (1 Hour)
Green Dot (30 Minutes)
Victims' Rights and Resources (30 Minutes)
When are you planning to hold this program?
Please provide three (3) dates and times that work best with your schedule.
Preferred Date 1
Preferred Date 2
Preferred Date 3
What time would you like the program to start?
Where are you planning to hold this program?
How many people are you expecting to attend this program?
Thanks so much for requesting a program from AVI. AVI staff will reach out to you in 2 business days. If you do not receive an email or phone call in two business days, please call the office at 609-771-2272.
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