Health Promotion Office

Request a Presentation

Thank you for your interest in one of our presentations or hall program kits! Please complete the form below to begin the process. A representative from the Health Promotion Office will reach out to you via email to coordinate the details of your request.

Program Request Form

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.
Passive Hall Program Kits for RAs
If you're an RA looking for us to provide a passive hall program kit, 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.