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Tobacco-Use Prevention Education (TUPE) Presentation Request Form
Please use this form to help us learn more about what your needs are for support in the area of TUPE.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Contact Phone Number
*
Your answer
School District Name
*
Your answer
School Name
*
Your answer
What areas of support are you interested in? (Check all the apply)
*
Parent Presentation
Teacher and Staff Presentation
Student Presentation
Other:
Required
If a student presentation is requested, what is the grade level or content area?
Your answer
What time of day were you looking for this support?
*
Time
:
AM
PM
When were you looking for the presentations to occur?
*
Your answer
Do you have any additional requests or suggestions?
Your answer
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