WOU: Safe Zone Intake Form

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Safe Zone training intake form

Please fill out the form and the fields below. We will use this information and contact you about the details of your Safe Zone training request. If you have any questions, contact us at safezone@wou.edu.

This intake form will allow the Safe Zone trainers to tailor the program to your specific group! The most effective trainings are those that allow us to know your audience, the needs, background and current level of knowledge.

Note: Please indicate if you are looking for Safe Zone Ally Training or general GLBTQ workshops.

  Safe Zone Ally Training   GLBTQ Workshop

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Contact name:

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Contact phone number:

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Organization:

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Contact E-Mail (required):

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Workshop date/time(s):

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Length of workshop:

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Location of workshop:

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Participant information

Number of participants expected:

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Age (Range):

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Gender (#) expected: F: M: T:

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Positions/roles in group:

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Ethnic/Racial backgrounds (#):

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Participant relationships (how well do participants know each other?):

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What process or goals do you wish to accomplish with this training or workshop?

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What might pose challenges for the participants to engage with comfort or honesty?

What will you do to ensure that the process starts in a way that provides "safety" with respect to the hospitality, physical and psychological needs of the participants?

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How will you prepare your group for this workshop/training and what follow-up will you do on the facilitations?

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What other information would you like to provide the Safe Zone trainers? (Specific requests, needs, etc.)

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Possible Safe Zone Training Options - do you have requests for activities or training modules that you are familiar with? If so, please indicate that below:

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Ally 1

  Left Handed Lesson

Sexual Orientation and Gender Identity

Line Up Warm Up

How Do You Feel About LGBTQ People?

Beyond the Binary

Media and Being LGBTQ

Heterosexual Privelage

History & Modern Pop Culure Match Up

Terminology Match Up

Coming Out Stars

Creating a Safe Zone and Being an Ally

An Effective Ally Does/Does Not

Ally 2

Goals and Outcomes

Beyond the Binary

Mattering and Marginality

Creating a Safe Zone and Being an Ally

The Cisgender Privelage Checklist

Terminology Match Up

If your on-campus presentation or workshop would require accommodations for disabilities, contact the Office of Disability Services at (503) 838-8250.

This submission form is submitted via e-mail.

After clicking this submit button you may be asked to fill in your email adress, you must do so to fully submit your information. You will NOT receive an e-mail notifying of your submission once complete, but the Safe Zone will contact you shortly following your request.

If you do not hear from someone from Safe Zone within 3 business days, contact us directly at safezone@wou.edu.

Contact

Student Leadership and Activities 503-838-8261 | or e-mail: wucofc@wou.edu

mindtrip.wou.edu Remote IP: 174.123.66.6 ((none!))

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