Something is Wrong: Exploring the Roots of Violence

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1. What is your contact information? [This will help us to track how the curriculum is being used]

What is your contact information? [This will help us to track how the curriculum is being used]   Organization/Affiliation:
City/Town:
State:	-- select state --AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
ZIP/Postal Code:
Country:
Email Address:

2. In what setting do you plan to use the curriculum guide?

In what setting do you plan to use the curriculum guide?   Elementary school Middle school High school College/University Community-based organization Faith community Other

3. With what age group will you use the curriculum?

With what age group will you use the curriculum?   youth (ages 11-18) youth (ages 19-24) Adults

4. With which population group(s) will you use this curriculum?

With which population group(s) will you use this curriculum?   African-American White Latino/a Asian-Pacific Islander Native American Arab American Young Women Young Men LGBTQ

5. How did you hear about the curriculum guide?

How did you hear about the curriculum guide?

6. Is there anything that you would like to add?

Is there anything that you would like to add?