KSC Mentors in Violence Prevention Peer Education Program Request Form.
Questions marked by * are required.
Name of who will be hosting program: *
Host's email address: *
Program will take place in a:
If Classroom, what is the course and is there a topical tie-in?
Choose a topic for your MVP program:
Alcohol & Consent: Does yes mean no?
Love Gone Wrong: Stalking & Cyberstalking
Just a Little Video:Revenge Porn
Crossing the Line: Healthy vs Unhealthy Relationships
Sexual Assault: A Men’s Issue?
Escalation: The Story of Yardly Love
Gender Roles: Why do they still exist?
The Air We Breathe: Toxic Masculinity
Notes on topic or other:
Choose a date or list possible dates for program:
Choose a time or range of times for program:
I will be able to provide:
Computer, Projector & Screen
Estimate of how many students who identify as non-binary will attend:
Estimate of how many students who identify as female will attend:
Estimate of how many students who identify as male will attend:
For Faculty Hosts: I agree that after I introduce the MVP Peer Educators I will leave the room so the program is truly peer education: