Health Promotion Office

Request a Presentation

If your organization is interested in hosting a health promotion program, or if you are an RA looking to host a hall program, please fill out the request form below. We will review your request and contact you to confirm the details or schedule a planning meeting.

Please note that we require at least two weeks’ notice before program is to be presented so that we may plan accordingly. Thank you for your understanding.

Program Request Form

Name (first & last)*
Student organization or residence hall name & number (for RAs)*
Email*
Phone number (area code required)*
Presentation of interest
Program "Other"
If you chose "other program" above, please give us a brief description of what you had in mind.
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?
Phone
This field is for validation purposes and should be left unchanged.