Listed below are the free services provided by the HIPRC. Submit a request form to be considered for services.

Event request

Submit the form below if you would like HIPRC to participate as an informational booth/table at a health fair, school/college fair, workplace event, community event etc.

Event Request Form

Name *

Name

First Name

Last Name

Email Address *

Organization *

Event Location *

Event Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event Date *

Event Date

YYYY

Time *

Time

Hour

Minute

Second

Event Type *

Total Estimated Attendance *

Audience *

Additional Information

resource request

Submit the form below if you would like to request HIPRC resources including: clearinghouse resources, HIPRC publications, NIH and SAMSHA national clearinghouse resources. For a list of resources available click here.

Resource Request Form

Name *

Name

First Name

Last Name

Email Address *

Address

If you would like the resource mailed, indicate the address you would like the resources sent to:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Planned use of resources *

Amount of resources *

Select the amount of resources needed:

Type of Resource *

Audience *

Message

Any additional information:

Date *

Date

When would you like to receive the resources by?

YYYY

borrowers' agreement

Submit the form below if you would like to check out a lending library resource including: books, DVDs and display boards. For a list of resources available click here.

Borrowers' Agreement Form

The Prevention Resource Center hereafter referred to as the PRC: A total of 5 books, 3 videos/DVDs and 5 display boards may be borrowed at a time for a period of 3 weeks. The PRC Shall not be held responsible for any copying of materials by borrowers that are in violation of state and federal copyright laws. If any borrowed materials are stolen, lost or damaged beyond use, the borrower or the borrower's organization shall owe the PRC a sum equal to the replacement cost of materials, plus a $5 replacement fee. If materials are irreplaceable, the borrower or organization shall owe the PRC the sum required to purchase comparable materials, plus a $5 replacement fee. Borrowers who return materials late will be charged 25 cents per item, per day after the due date, for a maximum of 30 business days. On the 31st business day after the due date, the materials are considered lost, in which case the borrower shall owe the PRC a sum equal to the replacement cost of the lost materials, plus a $5 replacement fee. Until all outstanding fees are paid the patron will not be able to borrow materials.

Name *

Name

First Name

Last Name

Email Address *

Phone *

Phone

(###)

###

####

Best Way to Get In Touch

Organization

Subject *

Message *

Work Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I, the undersigned, have read and understood the terms and conditions of the Borrowers Agreement of the PRC and agree to abide by the agreement. *

Presentation request

Submit the form below if you would like HIPRC to provide a general drug presentation at your middle or high school. Topics covered include: alcohol, underage drinking, marijuana, tobacco, e-cigarettes, spice, meth, ecstasy, predatory drugs, alcopops, inhalants, heroin, cocaine and prescription and over-the-counter drugs.

Presentation Request Form

Name *

Name

First Name

Last Name

Email Address *

School *

School Address *

School Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date *

Date

YYYY

Time *

Time

Hour

Minute

Second

Number of Students *

Grade Levels

Subject *

Message *

Additional Information

Listed below are the free services provided by the HIPRC. Submit a request form to be considered for services.

Event request

resource request

borrowers' agreement

Presentation request

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