CAPS: Wellness Peer Educators - Program Request Form
Please complete the following fields to request your outreach, workshop, or tabling event.

We recommend that all program requests be made at least 2-3 weeks in advance. Three (3) or more weeks is preferable.

Programs are available during business hours (Monday-Friday, 8:00a.m.-4:30p.m.). We may be able to accommodate requests for programs after hours, but it is not guaranteed.

Please note, this request form is not for graduate and professional student programming. These requests should be completed through the general CAPS program request portal or sent directly to the CAPS Program Manager for Graduate and Professional School Students, Dr. Christina Lambert.


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CONTACT INFORMATION
Please complete all fields.
Your Name *
Your Title/Role *
Your Organization or Group *
Phone *
Email *
Best method to contact you: *
Required
If applicable: Secondary Contact Person and their Phone/Email
PROGRAM REQUEST INFORMATION
IMPORTANT: If you are requesting a program from the CAPS staff (and not the Wellness Peer Educators), please complete the "Presentation & Outreach Event Request Form" at http://caps.ucsd.edu/signup
What type of program would you like? *
If you would like to request a workshop from the Tritons Flourish Workshop Series, please select from the topics below.
Visit the "Tritons Flourish Workshop Series" tab at http://caps.ucsd.edu/peer.html for a detailed description of each topic. Please choose only one program per request. If you wish to have additional programs, please complete a separate form for each topic.
Clear selection
Who will be the audience for this tabling event or workshop? *
What would you like the audience to gain from this presentation? *
To help guide your response, please refer to the "Tritons Flourish Workshop Series" tab at http://caps.ucsd.edu/peer.html for a detailed description of the topic you selected.
Estimated Length of Time for Presentation or Event: *
NOTE: The minimum amount of time needed to present a workshop is 30 minutes.  The only workshop topic we can present in under 30 minutes is “CAPS Services.”  We can provide a “CAPS Services” workshop anywhere from 15-30 minutes. Other workshop topics can be presented anywhere from 30-90 minutes.
Location of Program or Event: *
Expected Number of Participants: *
We require that there be at least 10 participants.
Tips for a successful event:
- Offer food as incentive for students to attend.
- Collaborate with another RA/organization to increase the chance of having a larger attendance.
- Have students sign up for the event ahead of time.
- Choose a date for the event when students are less likely busy (e.g. not right before midterms/finals, not on a Friday afternoon).
DATES AND TIMES
Please indicate the days and times for the proposed presentation.
1st Choice *
e.g., "Monday, September 30, 2013; 9am-11am"
2nd Choice
3rd Choice
Please tell us how you heard about us.
Check all that apply.
Anything else you would like us to know?
INSTRUCTIONS
Please submit the online form. Once your request has been reviewed, our Wellness Peer Educator Program's Student Coordinator will follow-up on your program request. If you have any questions, please contact CAPS at (858) 534-3755.

The person requesting the event is expected to control the audience and their behaviors.

If cancellation of an event is needed, please notify us at least 48 hours  in advance at wpe@ucsd.edu.

Please adhere to these guidelines. Failure to do so may inhibit our ability to offer additional programs or workshops to your group for the remainder of the quarter.

THANK YOU for your request!
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