Jeffco CTC Partner Display Material Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

(Approx. 5 minute form)

Thanks for your interest in sharing Jeffco CTC (www.jeffcoctc.com) coalition and youth created materials in the community! Please indicate which materials you'd like to receive in printed hard copies along with your contact information.

This is currently a pilot project. Coordination of all materials requested by December 2nd, 2021 will happen as Jeffco CTC staff is able to given limited end-of-year staff capacity. All materials requested by 12/22/21 can expect delivery end of December 2021/beginning of January 2022. All materials requested after 12/23/21 will be fulfilled as staff has capacity in 2022.

More information on each of these materials can be found here:
% posters: https://www.jeffcoteens.org/contest and https://www.jeffcoteens.org/jeffco-teen-data
"They Need You to Say No" posters: https://sites.google.com/prod/view/jefferson-county-ctc/current-projects/social-hosting-youth-policy-proposal
Twelve Talks printables: https://www.twelvetalks.com/printables
Free Parent/Guardian Workshops flyers (NSET/STC): https://www.twelvetalks.com/workshops
Twelve Talks Conversation Cards: https://drive.google.com/file/d/1AjlW-xnWUV1y5OvQ19w2bV_mmJTllfqi/view?usp=sharing
Jeffco CTC 2021 Risk & Protective Factor Data Report: https://sites.google.com/prod/view/jefferson-county-ctc/about/2021-jeffco-ctc-youth-data-report
Jeffco Teens poster: www.jeffcoteens.org and https://drive.google.com/file/d/1mwxAuY27DVW3SfkxvVhpMWIGBNAxhfI7/view?usp=sharing

Name *

Title *

Organization *

Email address *

Please select all materials you would like printed copies of *

% posters (teen audience) - 3 in a set

"They Need You to Say No" posters (parent/guardian audience) - 4 in a set

Parent/Guardian workshop flyers (NSET & STC) - in English and Spanish (front to back)

Twelve Talks Conversation Cards - set of all 12 topics (4" x 6")

Jeffco CTC 2021 Risk & Protective Factor Data Report

Jeffco Teens Poster

Other:

Required

1 set/copy

5 sets / copies

10 sets / copies

20 sets / copies

Other amount to specify below

% Posters

"They Need You To Say No"

Twelve Talks Conversation Cards set

Other Twelve Talks printables (specify below)

Parent/Guardian Workshop flyers (NSET & STC) in English & Spanish

Jeffco CTC 2021 Risk & Protective Factor Data Report

Jeffco Teens Poster

If different quantities are desired, please specify the item(s) and desired number of sets/copies.

(Example) "They Need You To Say No" - 25 copies; Twelve Talks Conversation Cards - 3 sets.

What is the best way to get these materials to you? *

The Jeffco CTC team will email you to set up a day, time, and location (if sending/delivering) that works for you.

I will pick them up at the Jefferson County Public Health Office at 645 Parfet St, Lakewood, CO 80215

I would like them dropped off at my workplace/another location

I would like them mailed to my workplace/another location

If you would like these materials dropped off or mailed, what address would you like them sent to?

Please write a short sentence indicating where you will display these materials. *

This is to reduce potential duplicity and so we know where these messages are being shared!

How many people do you estimate will see these materials displayed? For how long do you estimate they will be displayed? *

Any questions?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy