Safe Smart Dating Chapter Interest Form

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Hello and thank you for your interest in hosting Safe Smart Dating! Please complete the information below in order for your chapter to be considered for the workshop. The deadline to apply for the spring 2019 semester is December 1st. The deadline to apply for the fall 2020 semester is July 31st.

Email *

Please indicate your organization. *

Sigma Delta Tau

Zeta Beta Tau

Name of Chapter *

Name and Email Address of your chapter's coordinating officer *

This is the officer that will be responsible for planning the Safe Smart Dating program, and working with your assigned facilitators. If this contact is remaining the Chapter President, please indicate that here.

Which semester are you interested in hosting Safe Smart Dating? *

Fall 2019

Spring 2020

If you are a member of Sigma Delta Tau, is there a Zeta Beta Tau chapter on your campus?

Yes

Clear selection

If you are a member of Zeta Beta Tau, is there a Sigma Delta Tau chapter on your campus?

Yes

Clear selection

What is your 1st preferred workshop date? *

YYYY

What is your 2nd preferred workshop date? *

YYYY

What is your 3rd preferred workshop date? *

YYYY

Briefly describe why your chapter would like to receive the Safe Smart Dating workshop. *

Safe Smart Dating Expectations *

By checking "Yes" I certify that the chapter's coordinating officer has read and agrees to the terms of the Chapter Policies and Procedures document: https://docs.google.com/document/d/1ecJRp-UDZ1afc1Fxve4C1rhV0fg7X2ddRwl3b9dx8Vo/edit?usp=sharing

Yes

Required

Submit

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