Community Education Program Request Form

Current Prevention and Education Programs

Please note: At this time, we are unable to offer prevention programming for schools and/or other entities outside of the Denver-Metro area. The Blue Bench serves Denver, Adams, Arapahoe, Broomfield, Douglas, Elbert, Gilpin, Jefferson, and Lincoln County.

The Blue Bench offers a wide range of developmentally-appropriate sexual violence prevention and education programs to fit the needs of our diverse metro Denver communities. Please take a moment to tell us which program(s) you are interested in and we'll be in touch shortly!

Question Title

* 1. Contact Information

Name *

Organization Affiliation *

Address

City/State *

State/Province

ZIP/Postal Code

Email Address *

Phone Number *

Question Title

* 2. Please indicate which program(s) you are interested in (mark all that apply).

I would like to:

	Recieve information about this program by email	Book this program	Discuss this program with a staff member by phone
*Keeping Kids Safe/Keeping Youth Safe* for parents of young children/middle and high school students	*Keeping Kids Safe/Keeping Youth Safe* for parents of young children/middle and high school students Recieve information about this program by email	*Keeping Kids Safe/Keeping Youth Safe* for parents of young children/middle and high school students Book this program	*Keeping Kids Safe/Keeping Youth Safe* for parents of young children/middle and high school students Discuss this program with a staff member by phone
*Let’s Talk About It: Sexual Assault Prevention for Youth*, for middle school and junior high aged learners	*Let’s Talk About It: Sexual Assault Prevention for Youth*, for middle school and junior high aged learners Recieve information about this program by email	*Let’s Talk About It: Sexual Assault Prevention for Youth*, for middle school and junior high aged learners Book this program	*Let’s Talk About It: Sexual Assault Prevention for Youth*, for middle school and junior high aged learners Discuss this program with a staff member by phone
Uniting in Action: Creating a Culture to Prevent Sexual Violence for high school aged learners	Uniting in Action: Creating a Culture to Prevent Sexual Violence for high school aged learners Recieve information about this program by email	Uniting in Action: Creating a Culture to Prevent Sexual Violence for high school aged learners Book this program	Uniting in Action: Creating a Culture to Prevent Sexual Violence for high school aged learners Discuss this program with a staff member by phone
*Safe Bars* bystander intervention training for staff at alcohol-serving establishments	*Safe Bars* bystander intervention training for staff at alcohol-serving establishments Recieve information about this program by email	*Safe Bars* bystander intervention training for staff at alcohol-serving establishments Book this program	*Safe Bars* bystander intervention training for staff at alcohol-serving establishments Discuss this program with a staff member by phone
Other Presentation or Training (workshops can be customized to meet your group's needs)	Other Presentation or Training (workshops can be customized to meet your group's needs) Recieve information about this program by email	Other Presentation or Training (workshops can be customized to meet your group's needs) Book this program	Other Presentation or Training (workshops can be customized to meet your group's needs) Discuss this program with a staff member by phone

If you selected "Other" please describe what type of presentation or training you would like:

Question Title

* 3. If you would like to book a program for a specific date (or date range), please list the date(s) and time(s) here:

Question Title

* 4. Please share anything else you would like us to know about how we can meet your needs.

Question Title

* 5. Please indicate which of the following best describes your company/organization:

Question Title

* 6. What is your job title or role?

Question Title

* 7. Where did you hear about The Blue Bench Prevention and Education programs?

Thank you for your interest in The Blue Bench's Pathway to Prevention. We look forward to partnering with your organization to prevent sexual violence!

Question Title

* 1. Contact Information

Question Title

* 2. Please indicate which program(s) you are interested in (mark all that apply).I would like to:

Question Title

* 3. If you would like to book a program for a specific date (or date range), please list the date(s) and time(s) here:

Question Title

* 4. Please share anything else you would like us to know about how we can meet your needs.

Question Title

* 5. Please indicate which of the following best describes your company/organization:

Question Title

* 6. What is your job title or role?

Question Title

* 7. Where did you hear about The Blue Bench Prevention and Education programs?

* 2. Please indicate which program(s) you are interested in (mark all that apply).

I would like to: