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WIU Home > Student Services > Womens Center > Program Request Form > Program Request Form
All fields with * are required
Person making request: *
Position/Title: *
Address: *
Phone: (XXX-XXX-XXXX)
Email address: *
Program/Presentation Topic (check all that apply): * Following is a partial list of topics on which Women's Center staff can do presentations or help you find a speaker for a program/presentation. This is by no means a complete or exhaustive list, and some topics are similar or closely related. Many also are not exclusive to women and girls. Please check all that apply, and provide additional specific areas and elaborative comments. Also please add any additional relevant topics that are not listed. Feminism/Womanism (e.g., Feminist/Womanist Theories, Radical Feminism, Ecofeminism, First Wave, Second Wave, Third Wave, Feminist Men, Activism, etc.) Women's Studies Women's History/Herstory (at WIU; in the local community; regional; U.S.; International/World) Intersection of race, class and gender Women's Health (e.g., menstruation, pregnancy/childbirth, perimenopause, menopause, osteoporosis, breast cancer, lesbian health issues, body image/eating disorders, nutrition/ diet, exercise, gynecological health, mental health) Choice Issues (contraceptive, reproductive, abortion, etc.) Relationships (e.g., women's friendships; platonic opposite sex; co-workers; heterosexual dating and marriage; same -sex dating and commitments/unions; with heterosexual or same-sex partners, with parents; with children; family; separation, divorce, estrangement, loss, etc.) Gay/lesbian/bisexual/transgender issues/awareness/education Parenting/Childrearing (e.g., co-parenting, single-parenting, rearing strong daughters and sensitive sons, non-sexist childrearing, etc.) Childcare (e.g., availability/accessibility, cost, etc.) Care giving (of children, partners, aging parents, other family members, etc.) Sex-role stereotyping Non-sexist Language Home Repair and/or Automobile Maintenance Gender equity in education (elementary, secondary, post-secondary/higher education) Girls and women in athletics and recreational sports Women in Leadership (e.g., organizational, professional, governmental, etc.) Women in Politics/Government Women in the Military Employment issues (e.g., career exploration, pay equity, sexual harassment, re-entering the work force, starting a small business; unemployment, etc.) Women in Business (e.g., career opportunities, climbing the corporate ladder, women-owned businesses, etc.) Women in traditionally male-dominated fields/non-traditional academic and career fields (e.g., science, technology, LEJA/police officers, attorneys, judges; firefighters; medicine, construction; trades) Women and Finance (e.g., earning, saving, investing, and spending money wisely; bankruptcy; welfare, etc.) Women in Literature Portrayal of Girls and Women in the Media (e.g., films, television, advertising, magazines, video games, Internet, etc.) Objectification of girls and women Violence Against Women (e.g., rape/sexual assault, domestic violence, stalking, sexual harassment, emotional abuse, men's roles in stopping VAW, etc.) Gender Discrimination Women's Legal Rights and Legal Issues Women's Spirituality Women and Religion Women in the Arts Women of Color International Women Gender and Communication Self-esteem Time Management Stress Management Other (please specify)
Title of Program (if applicable):
Date Program/Presentation to be held: * (please allow at least 2 weeks from date of request)
Time Program/Presentation to begin: *
Program/Presentation length: * 15 min. 30 min. 45 min. 60 min. 75 min. Other
Location Program/Presentation to be held: *
A/V Equipment Needed:
Alternative dates/times:
Nature of group/target audience:
Estimated attendance:
Please add any additional information that may aid in planning the presentation:
Publicity will be done by: * Person making request Women's Center Other
Date publicity needs to be out:
Room will be reserved by: * Person making request Women's Center Other
Equipment will be reserved by: * Person making request Women's Center Other