Renew your charter with The BACCHUS Network!

2009 Charter Renewal

ALWAYS KEEP A HARD COPY OF THIS INFORMATION - If you do not get an email confirmation within 48 hours that we have received your renewal information, your computer server prevents you from filing online. In that case, you must fax or mail your form to us. Thanks. FAX 303-871-0907. Mail to: The BACCHUS Network, PO Box 100430, Denver, CO 80250-0430.

1. Database Maintenance/Correspondence: It is important that we have a dependable and current professional staff advisor name and address for your group. Your campus is responsible for notifying the national office immediately at any time this information changes.

What is your affiliated peer education group name?
College/University:
Advisor Name:
Advisor Title:
Mailing Address:

City:
State:
Zip:
Office Phone:
Fax:
Advisor E-mail Address:

Please provide the email of one peer educator who will be active in your group in 2009-2010 who is willing to receive BACCHUS Email and communication from our Student Advisory Committee:

Please provide your peer education group’s website if you grant us permission to post it on the Area Website portion of bacchusnetwork.org:

2. Peer Education Group Structure:Please check one.

Student activity club/organization
Serving primarily fraternities/sororities
Formal peer educator group with office/department
Peer theatre

Student Government
Part of a campus task force
Formal class/college credit
Athlete Mentors/Athlete Issues
Other:

3. Campus Environment: Please check one for each category.

Type of Institution:
Four Year	Two Year
Size of Campus:
Large (more than 12,000)	Medium (between 7,500 - 12,000)	Small (less than 7,500)
Affiliation:
Private	Public/State
Population:
Primarily Commuter	Primarily Residential	Mixed Commuter/Residential

4. Current Status: Please check one of the six options

	We have an ACTIVE student group, programming and meeting regularly.
	We have a TRANSITIONAL group, meeting and programming less than usual, but the group is still working together.
	We no longer have an active peer education group, but we have another group of peer educators on campus who would like to be affiliated. Please TRANSFER OUR AFFILIATION. (Reflect change in mailing information; question #1).
	We no longer have a group of students, but we are actively working on STARTING OVER and would like to remain in the Network for one year to re-group.
	We do not have a group and have no plans to establish one, and wish to be REMOVED from the network. If you select this option, what is the reason that your group no longer exists?
	We have not been successful in recruiting a peer education group and don't plan to, but we would like to continue to receive mailings for the next year.

5. If you marked yes to item 3C, 3D, 3F, would you like a member of the national staff to contact you to provide assistance?
Yes No

6. If you marked yes to item 3C, 3D, 3F, would you like us to send you a new affiliate starter kit?
Yes No

7. Our Educational Focus Is: Please rank order ONLY THOSE ISSUES WHICH APPLY to your group, #1 being highest priority.

alcohol abuse prevention
other drug prevention
general health and safety issues
sexual responsibility
STI's, STD's and HIV/AIDS
sexual assault

diversity issues
impaired driving prevention
tobacco prevention
health/fitness/nutrition
mental health
other

8. Student Involvement: Please tell us about your leadership and membership.
Number of students in leadership positions
Total number of student peer educators in your group
% of membership who is male
% of membership who is female
% of membership who are members of a fraternity/sorority
% of members who are student-athletes

9. Collaboration On and Off Campus: What other offices, departments or agencies have you worked with this year? Check all that apply.

Institution President's Office
Counseling Center
Dean of Students
Faculty
Greek Life Office
Health Education/Center
Judicial Affairs
Multicultural Affairs
Student Activities
Student Government
Orientation
Physical Education/Athletics

Residence Life
Safety & Security/Campus Police
Health/Wellness Office
Local High Schools
MADD
Police/Traffic Safety/Law Enforcement
State Governor's Highway Safety Office
State Department of Transportation
State/Community Tobacco Control Agency
State Health Department
Other:

10. Programming: Estimate the number of programs, awareness activities or events your group has done/will do this academic year.
Number of programs August - December, 2009
Number of programs January - July, 2009

11. Your Funding: Please estimate your group's budget for this academic year. Be sure to include all college/university money you receive, and sponsorships or award money received, grant money and estimated money that other organizations contributed to co-sponsor activities with you:

From what source do you receive the majority of your funding? Please select one.
Student Government/Student Activity Fee
Fundraising Efforts
Alcohol/Drug Education Office
Health/Wellness Office
Residence Life Office
Greek Life Office
Grant Funding- If selected, from who?:
Other:

12. Programming Issues: Which of the following issues have you/will you address for the 08-09 academic year? Check all that apply.

AIDS/HIV
Alcohol Poisoning
Cancer
Campus Safety
Dating Relationships
Drinking Alternatives
Drug Use / Prescription Drug Abuse
Eating Disorders
Family Issues(dysfunction, ACOA)
HPV/Cervical Cancer Prevention
Sexual Orientation Issues
Hosting Safe Parties
How To Help A Friend With A Drinking Problem
Impaired Driving Prevention
Understanding Addiction
Laws/Campus Policy
Performance Enhancing Drugs
Predatory Drugs

Body Image
Self-Esteem

Mental Health
Multicultural Issues
Nutrition/Health/Fitness
Risk Management
Safe Rides/Designated Drivers
Safer Sex
Sexual Assault/Rape
Sexually Transmitted Diseases / Infections
Tobacco Cessation / Tobacco Policy
Stress/Time Management
Violence
Depression / Suicide
Other:

13. Organization Success:
What was the best program you did this year? Why was it a success?

14. Have You Used or Will You Use Any of The Following BACCHUS Resources during The 2008-2009 Academic Year: Check all that apply.
Educational Resource Materials:

Pamphlets, Posters Certified Peer Educator (CPE) Training	Other BACCHUS Programs (such as Alcohol Poisoning Response Kit or STEP)
Alcohol Response-Ability™ online alcohol education sanction course	Foundations for Student-Athletes™ online education course

Health Promotion Campaigns:

Alcohol Awareness/Impaired Driving Prevention Campaign (October)
Tobacco Cessation & Policy Development (November)
Sexual Responsibility Week

Safe Spring Break

Communication:

Websites (bacchusnetwork.org, smartersex.org, tobaccofreeU.org, friendsdrivesober.org
Electronic Area Newsletters
BACCHUS Facebook
BACCHUS Blog

The Peer Educator™
BACCHUS Listserv

Volunteers/Staff:

National Staff
Area Consultants

State Coordinators
Student Advisory Committee

Conferences:

Area Spring Conferences	General Assembly
Social Norms Conference

If you have not attended any of the above, what prevents you from doing so?

15. Of all the resources LISTED in #14, please list the top three in importance to your affiliate group.

16. Please check the following if your campus planned or will plan at least one program as part of the following awareness weeks during the 08-09 academic year.
National Collegiate Alcohol Awareness Week/Impaired Driving Prevention
Collegiate Tobacco Smokeout
Sexual Responsibility Week
Safe Spring Break

17. Do You Believe Your Peer Education Group Created Positive Change on Your Campus This Year?
Yes No Don't Know

If yes, PLEASE CHECK those strategies which apply to how you created change.
Awareness campaigns
Educational workshops/programs
Social Norm campaign
Service learning opportunities
Members being role models for others
Addressed unhealthy behaviors, attitudes, myths or misperceptions on campus
Helped change campus policy
Created more alcohol-free social functions
Offered attractive alcohol-free beverage service
Other:

18. What General Prevention Strategies Does Your Institution Use: Check all that apply.
Awareness campaigns
Educational workshops/programs
Alternative social functions
Environmental assessment/management
Social norms campaign
Campus policy creation/review
Motivational Interviewing

19. Value of Affiliation with BACCHUS: Please check ONE of the following.
Our group benefits a great deal from its affiliation with BACCHUS.
Our group benefits somewhat from its affiliation with BACCHUS.
Our group does not benefit from its affiliation with BACCHUS.
Please explain response:

20. Your Comments: Please provide any additional information or requests.

21. If BACCHUS were to create one new resource for you to use on campus, what would it be?

22. Are you aware that BACCHUS has started an Alumni & Friends Program? .
www.bacchusnetwork.org/alumni Check One.

Yes No

If you would like to send a listing of your 2009 graduating peers with name, mailing address and emails - we will add
them to our alumni network. Email admin@bacchusnetwork.org

23. Would you provide a name, title and mailing address of a professional from another campus who might consider affiliating with BACCHUS?

Name:
Title:
Email:
Address:
City / State:
Zip:

24. New Affiliates Only. Complete only if you chartered AFTER July 1, 2008.
How did you find out about The BACCHUS Network™?
Contact at an area conference
Contact with an area consultant or state coordinator
Attendance at General Assembly
Contact with a national staff member
Website
Referral from another campus professional
Referral from another campus student
Through review of our educational materials
Contact at professional conference; which one

Get to know your Regional Leaders. 12 Area Consultant Volunteers are local campus resource agents.
Contact them by e-mail.

Area 1 AK, ID, OR, WA - Mark Shaw, University of Washington (mshaw@u.washington.edu)
Area 2 AZ, CA, HI, NV - Cyndra Krogen, California State University - Sacramento (krogenc@csus.edu)
Area 3 CO, MT, UT, WY - Tricia Bishop, Salt Lake Community College (tricia.bishop@slcc.edu)
Area 4 IL, MN, SD, ND, WI – Amy Melichar, Marquette University (amy.melichar@mu.edu)
Area 5 IA, KS, MO, NE - Joan Masters, University of Missouri-Columbia (mastersj@missouri.edu)
Area 6 AR, LA, NM, OK, TX - Kim Harvey-Livingston, University of Texas - Tyler (kim_harvey-livingston@mail.uttyler.edu)
Area 7 OH, MI, KY, IN - Marc West, Baldwin-Wallace College (marcw@bw.edu)
Area 8 AL, MS, TN - Marianne Luther, Rhodes College (lutherm@rhodes.edu)
Area 9 FL, GA, SC, PR - Nanette Vega, University of Miami (nvega@miami.edu)
Area 10 CT, MA, RI, ME, NH, VT - Lisa Currie, Wesleyan University (lcurrie@wesleyan.edu)
Area 11 PA, NY, NJ - Jane Jones, Colgate University (jajones@mail.colgate.edu)
Area 12 VA, MD, DE, DC, WV, NC – Georgia Childs, Eastern Carolina University (childsg@ecu.edu)

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