Inqueery Peer Education Presentation Request Form

Inqueery Peer Education Presentation Request Form

Inqueery Peer Education Presentation Request Form

1. Name

Check all that apply.

2. UIS Affiliation

required

2. UIS Affiliation

Check all that apply.

Faculty

Staff

Student

Resident Assistant

Student Organization Officer/member

3. Title

4. Phone

5. Email

6. Campus Mail Address (If applicable)

7. Name of organization, class, or residence hall.

Please note that most of our programs are 60-90 minutes in length.

8. Time allotted for requested program or activity.

Please note that most of our programs are 60-90 minutes in length.

9. Estimated attendance.

10. Please indicate which program(s) you are interested in.

required

10. Please indicate which program(s) you are interested in.

Crossing the Line & Student Panel (An overview of LGBTQIA+ topics, laws)

Gender this Stick Figure (Educates on the limiting gender binary, biological sex vs gender vs sexual orientation)

Guess the Straight Person Gameshow (stereotypes, gender expression doesn't equal sexuality)

Let's Talk About Sex (Sex positive education, safe fun sex, consent)

None of the above

11. Preferred date for the program.

12. Preferred time for the program.

13. Preferred location for the program.

14. Please provide an alternate date for the program.

15. Please provide an alternate time for the program.

16. Please provide an alternate location for the program.

This question will help us understand the topic(s) you are most interested in particularly if none of the four available programs suits your needs.

17. Please check specific topics you are interested.

required

17. Please check specific topics you are interested.

This question will help us understand the topic(s) you are most interested in particularly if none of the four available programs suits your needs.

General LGBT Information/Issues

Bisexuality/Fluid Identities/Pansexuality

Transgender Issues

HIV/AIDS/STD's

Legal Issues

Parenting/Families

Relationship Issues

Issues in Education

Faith/Spirituality/Religion

Other

18. Other information or special request.

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