Send Silence Packing

Host Information Form

SSP Host Information Form

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Host Information

School/Organization Name First Name	Level of Involvement of Active Minds Chapter
Last Name	Email

Date & Time of Event

Please enter time in the format "1:00pm"

Date of Event

Does the standard timing of 7:30am (start set up), 9:00am (Event start time), 4:00pm begin tear down), 5:30pm (event end time) work for your event and community?

If no, please elaborate:

Day of Event Contact Information

Primary Contacts for Event

Name

Role (Faculty, student, etc)

Cell phone

Name

Role (Faculty, student, etc)

Cell phone

Marketing Department Contact Information

Name	Role
Email	Phone

In the case that a problem arises on the day of the event, who can the SSP staff call for immediate support?

Name

Role (Faculty, student, etc)

Cell phone

Name

Role (Faculty, student, etc)

Cell phone

Truck Parking

Truck access and close proximity to the display are of the utmost importance. The SSP truck is a large 16' box truck (think: moving truck) and you may need special permissions and permits to ensure that it can be parked

Where will the truck be parked for the event?

Are there any barriers or obstructions that the truck will need to navigate? (such as low-hanging trees, bridges, gates, etc)

Are there necessary permits for that space?

Please upload a campus map highlighting the indoor and outdoor location, the truck unloading and parking spots, and the locations of 6 content advisory signs and respective alternative route signs that passersby can take to avoid the display. (PDF Format only, if you have a map in another format you please print/save as pdf)

Outdoor location Information

What is the official name, address, and location of the area reserved on campus for outdoor display?

Where should the truck meet the event organizers for the outdoor location? Can we park here?

Are there restrictions on where we can and cannot place backpacks?

Indoor location Information

What is the official name, address, and location of the area reserved on campus for indoor display?

Where should the truck meet the event organizers for the indoor location? Can we park here?

Are there restrictions on where we can and cannot place backpacks?

T-shirt Ordering Form

Please select up to 25 t-shirt sizes	Total free shirts (must be 25 or less)
S	M
L	XL
2XL	3XL
4XL	5XL
Would you like to purchase additional shirts?

Additional Shirts ($10 each)

S	M
L	XL
2XL	3XL
4XL	5XL
How would you like to pay? Total paid shirts Total Amount ($)

Payment Information

Name on Card	Card Number
MM YY Code	Billing Email

Shipping Information

Recipient Name	Shipping Address Line 1
Shipping Address Line 2	Shipping City
Shipping State	Shipping Zip

Campus Climate

How does the campus typically respond to programming about mental health?

Mental health resources available on this campus or in the community: (i.e. Are counseling sessions covered by student insurance? Are a certain number of free sessions offered through the Counseling Center?  Is there a local free or low-cost mental health clinic in your area? Please list all applicable)

Describe how you would advertise and promote the display to your community.

Is there any additional information that we should know about your campus?

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