Ed Program Forms

ESCAPE

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Brochures:

Domestic Violence Sexual Assault

Mutual Ground Prevention Education Program Forms in pdf:

Program Request Form:
To request a program, please complete the Program Request Form. It can be mailed to Rhonda Annala, Mutual Ground, P.O. Box 843, Aurora, IL 60507 or sent as an attachment via email to rmannala@hotmail.com

Program Request Form

Pre/Post Tests:
It is imperative that we are able to document the success of our programs. Testing the students before and after our presentations is one way we can accomplish this. It is important that you print out one copy of each test per student. The presenter will return the tests to Mutual Ground.

Bully Quiz/Kids for Kindness

Grades 3 & 4 Pre and Post Test/Domestic Violence

Grade 5 Pre and Post Test/Domestic Violence

Grade 6 Pre and Post Test/Domestic Violence

Middle School Pre and Post Test/Dating Violence

Grade 6 Pre and Post Test/Sexual Harassment

Grade 7 Pre and Post Test/Sexual Assault

High School Pre and Post Test/Dating Violence

Program Presenter Evaluations:
These forms allow you to evaluate the program and the presenter. Your feedback is important to us! Statistical data from these evaluations is another means to document the results of our programs and the effectiveness of our presenters. You can return this form to the presenter or mail it to Rhonda Annala, Mutual Ground, P.O. Box 843, Aurora, IL 60607.

Tracie Bell
Vicki Bucio
Andrea Klimpke
Amy Medlin
Vanessa Nunez

For information or to set up a program please call
Rhonda (630) 897-0084 x107