Request a Presentation - University Health Service

Thank you for your interest in one of our presentations! Please complete the below form to let us know what type of program you are interested in hosting. One of our Peer Health Advocate interns will be in contact to finalize the details with you. Exact scheduling of the day / time of this program will be coordinated with the intern you are assigned to work with.

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

Name (first & last)*
Student organization or residence hall name & number (for RAs)*
Email*
Phone number (area code required)*
Description of Program Requested*
Please describe the type of presentation or program you have in mind.
Desired location of program / presentation*
(Please include building number, room number or name, and any other pertinent information.)
What general days of the week and times of the day would you like to offer your program? Please provide us with a few different options.*
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.