InterAct Youth Educations Services Request For Services Form

    Contact Information for Person Requesting Services

    Telephone

    School Contact Information

    Telephone

    Services

    Please indicate services requested by checking box next to desired presentation(s).

    Elementary School Topics
    Loving Yourself, Valuing OthersSafe At HomeDon't Lose ControlFair PlayGood Touch/Bad TouchPositive Connections

    Middle School Topics
    Loving Yourself, Valuing OthersTeen Dating ViolenceDon't Lose Control!Sensitivity and Sexual HarassmentResisting Peer Pressure

    High School Topics
    Teen Dating ViolenceSexual Harassment and StalkingHealthy RelationshipsLoving Yourself, Valuing OthersSelf-Control