Rape Assistance & Awareness Program : Programs & Services : Victim Services : PSSW/PSSG Class Information Form

Programs & Services

Information Sheet for Setting up a Private PSSW/PSSG Class

Organization/Group name:

Contact name:

Best way/time to contact:

Phone number(s):

Email address:

Fax number:

Mailing address:

Length of class desired:

Number of participants:

Age of participants:

Desired date(s):

Desired time(s):

Able to provide own space:

	Yes
	No

Special Needs:

Additional comments/information: