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