Wellness Education – Workshop Request Form Wellness Education – Workshop Request Form Contact Info First Name * Last Name * TCU Email * Phone * Are you the primary contact for this program? Yes No (If No, please list the name and phone number of the primary contact) Group Info What group is requesting these games/activities? * TCU Student Organization TCU Residence Hall Other Specify Group Name * What is the purpose for this program/event? * Please provide three date and time options for this program. Two of the times can be on the same date, but we need at least two different days. Program start times should be before 7:30pm. Date 1 * Time 1 * 121234567891011 : 0030 AMPM Date 2 * Time 2 * 121234567891011 : 0030 AMPM Date 3 * Time 3 * 121234567891011 : 0030 AMPM Additional Information Will you be present for the entire time of the program, including set-up approximately 20 minutes before the start time? Yes No If No, please list an alternative contact (name and phone number) who will be present when you are not. What is the location for the program/event? * What is the estimated attendance? If you are you planning this event with another person or group, please list their name and contact information. How much is your budget for this program? (If there isn't a budget, enter None.) Select Activity Bystander Intervention Training (50 -75 minutes) Become a person who chooses to take positive action when faced with situations where individuals need assistance. Health & Wellness Campus Resources (25 minute & 50 minute versions) Learn the ins and outs about campus resources that support your health and wellness, from the student point of view! Question, Persuade, Refer – Suicide Prevention Training (50 minutes minimum required) Participants in this presentation will leave with practical knowledge for helping others who might be at risk for suicide and/or are experiencing a mental health crisis. TIPs University - Training for Intervention Procedures (3 hours; $15 person for materials) This evidence-based, nationally recognized, bystander intervention program gives students the skills and confidence to intervene in situations where alcohol may be misused or increasing risk. Is there any other information or specific ideas for your program would like to share with us at this time? Submit Δ
