Program Request Form

Student Wellness Programs

Reminders and Basic Information

The form guides requestors through the basic information needed to book a Student Wellness facilitated program for your class, student organization, or department.

Please keep in mind that a minimum of five participants is required to move forward with the program. We recommend requesting a program with at least two weeks' notice to allow for adequate planning and preparation.

A Student Wellness team member will reach out to confirm details and coordinate the program. If anything needs to change in your submission, please work with the team member assisting you.

Name

Email Address

What type of organization do you represent?

Select The Desired Program

Is there any information that would be helpful for the presenter to know before presenting to your group/ organization? If "yes," please describe, otherwise please type"N/A."

Audience

Location of Presentation

Approximate Number of Participants

Ideal Date and Time of Presentation

Are there any accommodations your attendees will need to ensure accessibility of the presentation? If "yes," please describe, otherwise please type"N/A."

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

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Student Wellness Programs

Reminders and Basic Information

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