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SEEKING SUPPORT?
The Alliance has compiled a number of resources available for survivors, their friends and families, and professionals assisting survivors in New York City.

If you are interested in learning more about services offered by the Campus Training Institute, please complete the form below and send it to our Senior Campus Coordinator, Jeenie Yoon, at jyoon@svfreenyc.org or our Training and Technical Assistance Coordinator, Nastia Gorodilova, by email at ngorodilova@svfreenyc.org or by fax at (212) 229-0676.

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NYC Alliance Campus Training Institute Training/Workshop Information Form


Name of School:                                                                                                                                    

Main Contact person:                                                                                                                                      

Email:                                                                                     Phone #:                                                            

Date of Training/Workshop (list top 3 dates below):

1st Choice:                                                  2nd Choice                                    3rd Choice:                                   

Name of Workshop Requested:

                                                                                                                                                           

If you are not requesting a specific workshop, what topics would you like covered in our presentation?

                                                                                                                                                           

If different from above, who should we contact about room reservation and AV/Presentation needs?

Name:                                                                                                                                                             

Email:                                                              Phone:                                                                                    

DETAILS

Address:                                                                                                                                                

Building and Room Number:                                                                                                                       

Is there anything we need to know about how to enter the building? (i.e. present ID, coming in from a different street, etc.)

                                                                                                                                                           

Timeframe the room will be available:                                                            

Estimated # of Participants:                                                                        

Who will be participating? (i.e. Students, faculty, both?)                                                            

If you had to guess, what level of knowledge/expertise would you say the participants have surrounding this workshop topic on a scale of 1-5? (1=very low, 5=very high):                                   

Which campus staff members will be on site during the presentation?
Please list name, and their role at the school.
(We require someone on campus to be present in the event that students will have specific questions about the school’s procedures and policies)