Wellness Program Request Form

Is your group wanting to learn more about health and wellness? Do you have a specific topic in mind or an idea for a program or presentation? We offer a variety of health and wellness programs for our campus community. If you are hosting an event of your own, you can also request counselor support to be present at your event. Counselor support is for programs or activities that may be triggering for some attendees and would benefit from having a counselor present to respond to a student who needs to process feelings that have come up for them while attending the event.

To request a presentation, please fill out the form below. If a specific topic is not listed below, select the health and wellness category that best fits your request and describe your topic under "other." Presentation requests must be made at least four weeks in advance. This allows us time to coordinate staff coverage for requests and other details.

Contact Information

First name *

Last name *

Name of organization/department

Relation of the organizer to the audience 🛈

Phone *

Email *

Engagement Details

Note: Requests must be made four weeks in advance.

Date Requested * +

Time *

Alternative date * +

Alternative time *

Length of presentation *

Location *

In-person location *

Virtual platform link *

Please describe how social distancing measures will be addressed at the in-person location *

Who is the audience

Anticipated audience size 🛈

Are there any accommodations for audience members to be addressed? 🛈

Presentation Topic

What topic are you requesting? *

Are there any specific details you want to be covered on the selected topic? *

Request for counselor support at other events * 🛈

Yes