REQUEST FOR CARE PROGRAM WORKSHOP
For questions regarding CARE workshops, or if you experience a problem submitting your request, please contact Rob Buelow at 949-824-3005. Troubleshooting

Organization or Hall Contact Person Name Email Phone Staff Advisor (if different than Contact Person) Name Email Phone Location of Workshop Date & Time (Select at least 2 dates/times) < November 2009 > Su Mo Tu We Th Fr Sa 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 1st Choice: [Please Select a Date] (time) e.g. 9:00 AM < November 2009 > Su Mo Tu We Th Fr Sa 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 2nd Choice: [Please Select a Date] (time) e.g. 9:00 AM < November 2009 > Su Mo Tu We Th Fr Sa 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 3rd Choice: [Please Select a Date] (time) e.g. 9:00 AM We cannot guarantee that your workshop request will be honored due to the storage and/or unavailability of staff during the particular date/time requested. Chances of honoring requests are greater if there is an alternative date and time, and if the request is submitted at least 2 weeks in advance. Thank you for your cooperation. Approximate Length of Workshop: 15-30 minutes 30-60 minutes 60-90 minutes Other Number of People Expected: Who is the audience and what would you like for them to gain from this workshop?   Presenter Requested: Please select the presenter you would like to request for this workshop. Another speaker may be assigned based on availability or knowledge level for the topics requested. Robert Buelow, Violence Prevention Coordinator - provides workshops and trainings on the awareness and prevention of sexual assault and intimate partner violence, consent, bystander intervention, risk reduction, alcohol and rape drugs, women’s self-defense, and campus/community resources Right to KNOW - Right to KNOW is a female peer-education group that presents interactive workshops on dating and consent, sexual assault awareness and survivor support, interpersonal assertiveness and building positive relationships. CHAMPS (Challenging All Men to Prevent Sexism) - CHAMPS is a male peer-education group that focuses on the awareness and prevention of sexual assault and relationship violence. CHAMPS can provide workshops about gender socialization, healthy communication between intimate partners, and ways to stand up against sexual assault as a bystander. Mandy Mount, Ph.D., CARE Director - specializes in staff/RA trainings regarding sexual assault and intimate partner violence, crisis intervention, gender, sexuality, and multicultural issues, resources and referrals, and academic/career development What areas do you specifically want addressed? Please refer to the CARE Programming Topics for more information.   Any other pertinent information?   Format for Evaluations: Your feedback about our workshops is important to us. Please select the format that you prefer to fill out our evaluations. For paper-based evaluations, we will bring evaluation forms for the number of people expected. For online evaluations, we will provide a link to our evaluation form to be completed online. Paper-based EvaluationsOnline Evaluations