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Student Health Advocate Workshop Request Form
The Student Health Advocates are an integral part of the Health Promotion Services department at UC San Diego. They facilitate a number of FREE educational workshops on a variety of health and wellness topics for the UC San Diego community.

Please note that the date of your requested workshop must be at least 2 weeks from today.

Questions? Contact Vivian Lau, Health Promotion Assistant, at vilau@ucsd.edu or 858.822.0455.

Contact Person *
Please include your first and last name.
Your answer
Organization or Department Name *
RAs/HAs: Please indicate your college or area (The Village).
Your answer
Phone Number *
xxx-xxx-xxxx
Your answer
Email Address *
Your answer
Location of the Workshop *
Please include the building name, room number or name, and any other applicable information.
Your answer
Number of Participants Expected *
Please note that we require at least 10 students to be in attendance.
Your answer
Please briefly describe the participants. *
Example: First year residents, student org members, etc.
Your answer
Workshop *
Please select the workshop that you would like the SHAs to facilitate for your group. To view workshop descriptions, visit http://bit.ly/2ovrn9O
What is the desired length of the workshop? *
Preferred Date & Time *
Please indicate your preferred date & start time for the workshop. Your requested date must be at least 2 weeks from today.
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Alternate Date & Time *
Please indicate your alternate date & start time for the workshop. This date & time will be used if your preferred date & time is unavailable.
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Additional Comments / Special Requests
Your answer
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