Interpersonal Violence Awareness Program

Please complete this form when your department is sponsoring an event or program with a focus on interpersonal violence awareness including but not limited to dating violence, domestic violence, sexual harassment/assault, stalking, consent, etc.

The EIU Interpersonal Violence Awareness Team can assist in promoting your event.

Name of Program Contact Name of Program Contact * First Last
Department *
Phone Phone * - ### - ### ####
Email *
Title of Program *
Brief Description
Date Of Event Date Of Event * / MM / DD YYYY
Location *
Time of Event Time of Event * : HH MM AM/PM