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Health Promotion Program Request Form
Our Campus Health health educators and dietitians can bring a variety of interactive health and wellness programs to your class, club, or student group!
Presentations are available virtually or in-person.
Please allow 2 weeks notice if possible.
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* Indicates required question
Your Name
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Your answer
Department/Organization
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Your answer
Phone Number
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Your answer
Email
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Your answer
Program Requested
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Please select the program you would like to request
Bear Down on Health & Wellness
Campus Health 101
Digital Detox
Food & Mood Connection
Healthy Boundaries
Navigating Relationships
Nourishing Choices & Campus Life
Nutrition Myth Busting
Nutrition [Name Your Topic]
Mental Health, Self-Care, Suicide Prevention
RedCup Q&A
Rx Safely
SexTalk
Sleep & Self-Care Party
Sleep & Stress
Stronger Than: The Power of Perspective
The Buzz
QPR Suicide Prevention: Question, Persuade, Refer
Other:
Please provide the location of the presentation (if virtual, please write "virtual")
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Your answer
Primary Date
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MM
/
DD
/
YYYY
Time (i.e., 12-12:50pm)
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Your answer
Secondary Date
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MM
/
DD
/
YYYY
Time (i.e., 12-12:50pm)
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Your answer
Expected Number of Participants
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Your answer
Additional Comments
Your answer
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