Center for Health and Wellness Promotion

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Presentation Request

The Center for Health & Wellness Promotion organizes educational outreach, promotion, and training efforts to increase the well-being of the campus community.  These services are available by completing the Student Wellness Presentation Request.

Personal Information (for individual currently completing the form)
First Name:
Last Name:
Department or Organization:
Phone Number:
E-mail:
Presentation Information
Date of Presentation:
Start Time:
End Time:
Department, Organization, or Target Audience
Duration of the Presentation:
Number of Students/Participants expected:
Location of Presentation:
Topic(s) Requested:
If Other, please specify:
Goals of the workshop and/or outreach:
 
Special requests/specific reason for this request:
 
Has the presentation been requested before:
If Yes, when:
Wellness Boards
I would like to request a copy of the following Wellness Boards (check all that apply):
Date you would like to pick up the Boards (please allow 48 hours for your boards to be printed): (mm/dd/yyyy)

Please click Submit only once.