Health Promotion Office

Request a Presentation

Thank you for your interest in one of our presentations! Please complete the below form to let us know what program you are interested in hosting. One of our Peer Health Advocate interns will be in contact within 48 hours to finalize the details with you.

Due to the COVID-19 pandemic, we are NOT offering Cold Care Kits or Safe Sex Supply Kits. If you are an RA in need of an RA Safe Sex Supply Kit, please email Zoe at zblack@uhs.rochester.edu to arrange a pick up. An RA Safe Sex Supply Kit contains 20 external condoms, 10 samples of lube, 2 dental dams and 2 internal condoms. Each RA is allowed to request one kit per month.

Name (first & last)*
Student organization or residence hall name & number (for RAs)*
Email*
Phone number (area code required)*
Presentation of interest
If you're looking for us to provide a presentation, please choose one from the below options.
Other request
If you would like a presentation other than our standard offerings listed above, please provide us a description here.
Preferred date and time
Alternate date and time
Desired length of the program
Desired location of program / presentation
(Please include building number, room number or name, and any other pertinent information.)
Number of participants expected
How do you plan on promoting the program?
Will there be an incentive for people to attend? If yes, describe:
Do you have a budget for this program? If yes, how much?
Name
This field is for validation purposes and should be left unchanged.