CHEW Program Request CHEW Presentation Request Form Step 1 of 2 50% All presentations require a minimum notice of at least two weeks.Presentation requests that do not provide a two-week advance notice are not guaranteed to be scheduled. Please contact wellness@utk.edu if you have questions.Name* First Last E-mail* Enter Email Confirm Email Name of group, class, or residence hall:*Where would you like for this presentation to be held?*Please make sure you reserve a space for this presentation. If you need assistance, call us at 865-974-5725.Will this presentation fulfill a sanction requirement from the Office of Student Conduct & Community Standards or Office of Sorority & Fraternity Life?* Yes No Which presentation are you requesting?Which presentation are you requesting? ConsentEdu Feeling Your Best at UT (General Wellness) Goodnight, Vols (Sleep Hygiene) Healthy Relationships Know the Standard (Alcohol Education) Mind Your Meds Recovery Ally Training Sexual Health 101 Survival Guide to Stress (Stress Management) Vols ACT: Bystander Intervention Training Vols Care: Supporting Survivors of Sexual Misconduct Welcoming Mental Wellness Custom Recovery Presentation Rocky Top Recovery Overview Custom Relationship & Sexual Violence Prevention Presentation Mind Your Meds PresentationWhat is your first choice date?* MM slash DD slash YYYY What is your first choice time?* : Hours Minutes AM PM AM/PM What is your second choice date?* MM slash DD slash YYYY What is your second choice time?* : Hours Minutes AM PM AM/PM This field is hidden when viewing the formThe Resilient Volunteer PresentationThis field is hidden when viewing the formWhat is your first choice date?* MM slash DD slash YYYY This field is hidden when viewing the formWhat is your first choice time?* : Hours Minutes AM PM AM/PM This field is hidden when viewing the formWhat is your second choice date?* MM slash DD slash YYYY This field is hidden when viewing the formWhat is your second choice time?* : Hours Minutes AM PM AM/PM Survival Guide to Stress (Stress Management) PresentationWhat is your first choice date?* MM slash DD slash YYYY What is your first choice time?* : Hours Minutes AM PM AM/PM What is your second choice date?* MM slash DD slash YYYY What is your second choice time?* : Hours Minutes AM PM AM/PM Goodnight, Vols (Sleep Hygiene) PresentationWhat is your first choice date?* MM slash DD slash YYYY What is your first choice time?* : Hours Minutes AM PM AM/PM What is your second choice date?* MM slash DD slash YYYY What is your second choice time?* : Hours Minutes AM PM AM/PM Recovery Ally TrainingWhat is your first choice date?* MM slash DD slash YYYY What is your first choice time?* : Hours Minutes AM PM AM/PM What is your second choice date?* MM slash DD slash YYYY What is your second choice time?* : Hours Minutes AM PM AM/PM Vols ACT: Bystander Intervention TrainingWhat is your first choice date?* MM slash DD slash YYYY What is your first choice time?* : Hours Minutes AM PM AM/PM What is your second choice date?* MM slash DD slash YYYY What is your second choice time?* : Hours Minutes AM PM AM/PM Feeling Your Best at UTWhat is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Welcoming Mental WellnessWhat is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Know the StandardWhat is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Sexual Health 101What is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Healthy RelationshipsWhat is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY ConsentEduWhat is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Custom Recovery Presentation InformationWhat is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Please describe your custom presentation request. Possible custom presentation topics could include: general Rocky Top Recovery overview and resources, how to talk about recovery using person first language, the science of addiction, etc.*Nicole will reach out to discuss your custom presentation request with you in more detail, but any information you can provide here is helpful. Custom Relationship & Sexual Violence Prevention (RSVP) Presentation InformationThese will only be facilitated by Dr. Kayley McMahan (Dr. Mac), the RSVP Coordinator.What is your first date choice?* MM slash DD slash YYYY What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Please describe your custom presentation request. Possible custom presentation topics could include: contraception and pregnancy prevention; sexually transmitted infections (STIs); conception, pregnancy, and childbirth; sexual anatomy and physiology; specific content on types of sexual misconduct (e.g., dating violence, stalking); healthy interpersonal communication. Please try to limit the topics to no more than two, as this will be an hour program.*Dr. Mac will reach out to discuss your custom presentation request with you in more detail, but any information you can provide here is helpful. Vols Care: Supporting Survivors of Sexual MisconductVols Care will only be facilitated by Dr. Kayley McMahan (Dr. Mac), the RSVP Coordinator.What is your first date choice?* MM slash DD slash YYYY What is your first time choice?* : Hours Minutes AM PM AM/PM What is your second date choice?* MM slash DD slash YYYY What is your second time choice?* : Hours Minutes AM PM AM/PM Greek Letter Organization?Are you requesting this presentation for a Greek Letter Organization?* Yes No What is your chapter name?Is the presentation fulfilling a Greek SOFE requirement? Yes No FacilitatorDo you prefer VOLS 2 VOLS Peer Health Educators or CHEW Staff to facilitate the presentation? VOLS 2 VOLS CHEW staff No preference DetailsWhat is your group size? (Approximate)*Do you require any special accommodations?* Yes No Please describe what special accommodations you require:Please provide a brief description of your audience.*Sanction Requirements DetailsDeadline to complete sanction* MM slash DD slash YYYY Number of members in organization/group*Percent of members who need to complete program*Please select your preference of program components from the list below (to total AT LEAST 50 minutes): Select All ACTive Bystander: discuss & practice ways to take ACTion when someone may be at risk (30 minutes) We Got Your BAC: manage blood alcohol content, understand tolerance, discuss risk reduction strategies (30 minutes) Alcohol/Other Drug Overdose 101: recognize signs & symptoms & what to do, understand amnesty (10 minutes) Mixology: discuss & understand the impact of mixing substances (10 minutes) Perception, Reality, & Culture: discuss perceptions around use, understand actual use, consider impact (20 minutes) Adderall, Xanax, & Oxys, Oh my!: discuss prescription safety, understand misuse (20 minutes) Open Q&A: open discussion about all things alcohol, cannabis, and other drugs (30 minutes) Please provide a brief description of why your organization/group has been sanctioned to complete a program.*Please provide any additional, relevant information. 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