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2. First name
3. Last name
5. Email
6. Phone number
8. School/Organization name
11. Presentation topic (select all that apply)

    1. Mental Health: Coping Skills and Stress Management
    2. Importance of Consent
    3. STD/STI Prevention
    4. Professional Careers in Public Health
    5. Vaping (nicotine & cannabis)
    6. Opioids & overdose prevention, including Narcan training and resources
13. You selected "Vaping (nicotine & cannabis)"

    For a presentation specifically on vaping (nicotine & cannabis), please complete the Youth Substance Use Prevention Training Request Form. 

    1. Got it! I'll complete that form.
    2. I would like a different presentation - please contact me.
14. You selected "Opioids & overdose prevention"

    For a training specifically on opioids, overdose prevention, and Narcan, please complete the Snohomish Overdose Prevention request form here. 

    1. Got it! I'll complete that form.
    2. I would like a different presentation - please contact me.
16. Please describe the intended outcome(s) of the training. What skills or knowledge do you want the audience to gain?
18. Grade level of students (select all that apply)

    1. 6th-8th (middle school)
    2. 9th-12th (high school)
    3. College
19. Estimated number of people in attendance
21. Please describe who will be attending the training. (Ex. organizational leadership, volunteers, outreach staff, parents, students, etc.)
22. Please provide at least 3 possible dates/times for the training.
24. Training format

    1. Virtual
    2. In-person
    3. Hybrid (tech support for set up required)
26. Will interpreters be present?

    1. Yes
    2. No
    3. Uncertain
27. If requesting an in-person training, do you have the technology to connect a computer via HDMI to a TV screen or projector for visuals and audio?

    1. Yes
    2. No
29. Address of in-person training

    Include street address and, if applicable, suite or room number 

31. City
32. State
33. ZIP Code
35. What else do you want us to know?
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field