Program Requests

Student Health Center : Health Promotion : Program Request

Program Request

Please fill out the following form completely. You will be contacted by a Health Promotion staff member or peer educator to confirm your request and to make arrangments for your program. All program requests require at least a two week advance notice.

Please indicate the program you are requesting:

How to have a healthy relationship
Sex Under the Influence
Eating Well Made Simple Booked for September. October and November available.
Condom Sense
Safer Sex= Better Sex
The Absolut(e) Truth

Name:

Address:

E-Mail:

Phone:

Program Location:

Program Date:

Time:

Alternate Date:

Expected Attendance:

*For a program focused on the details of sexually transmitted diseases, visit the Women's Health Program page.