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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 Erica Okamura, Program Director, at eokamura@ucsd.edu or 858.534.1824.

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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Time
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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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Time
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Additional Comments / Special Requests
Your answer
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