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.

To request a presentation, please fill out the form below. 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 *

Who is the audience

Anticipated audience size 🛈

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

Presentation Topic

Describe the topic(s) you would like to be addressed during the presentation. *