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REQUEST FOR CARE PROGRAM WORKSHOP
For questions regarding CARE workshops, or if you experience a problem submitting your request, please contact Zahabiyah Khorakiwala 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)

May 2013

1st Choice: [Please Select a Date] (time)

May 2013

2nd Choice: [Please Select a Date] (time)

May 2013

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.

Zahabiyah Khorakiwala, 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
CARE Speakers Bureau - The CARE Speakers Bureau consists of individuals who are willing to discuss personal experiences for the purpose of increasing awareness of these issues and to help community members in developing a sense of personal power in identifying and safely intervening in situations that may lead to sexual assault
CARE's VIP program is an organization of representatives from the UC Irvine Greek Community who are committed to addressing the issues of rape, sexual assault, dating and domestic violence, and stalking on our campus.

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