SHS Health Promotion Program Request Form
Please fill out the following information about your request. 
In order to ensure we have appropriate staffing, we ask that you complete the form at least 2 weeks in advance. 
If you are an RA or Student Leader wanting to get trained on a health topic to facilitate for your residents/members please select TRAINING as your health topic.  
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Organization/Class Name *
Contact Person *
First & Last Name
Contact Person Email *
Please provide TWU Email
1st Choice Date *
MM
/
DD
/
YYYY
Start Time  *
Time
:
End Time  *
Time
:
2nd Choice Date *
If time of program would change for the 2nd choice date, please provide the 2nd choice time in the Additional Information (last question)
MM
/
DD
/
YYYY
Estimated Attendance *
Program Location *
Include Building & Room # or Zoom Link
Topic Requesting (Pick main topic, if there's additional information you'd like for us to cover, please include that in additional information): *
Additional information you want us to know about your program request: *
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