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Reno County Health Department Educational Program Request

  1. Approval is required for under 18 years of age - see below
  2. Topics To Be Covered*
  3. Date and topic reviewed by Health Department Coordinator/Supervisor/Director?
    If program reaches individuals under the age of 18 years of age, topics on Family Planning, Birth Process, Menstruation, Sexuality, etc., require administrative approval:

    *Principal/Administrator must give prior approval of topics to be covered.
  4. The Following Steps Are Also Recommended:
    1. Consideration of parental permission slips regarding topic.
    2. Consideration of inviting parents to come to program also or holding a special program for parents.
    3. Review of class preparation for the topic to be covered prior to the program.
    (What has been covered before this topic and what will come next.)

    *If handouts are to be given for these topics, principal and teacher to preview ahead of time and will be responsible to distribute them.

    The intent of this form is to decrease problems from developing with sensitive issues and to be sure the Health Department staff is consistent in its materials and presentations.
  5. Leave This Blank:

  6. This field is not part of the form submission.