Request edit access
Health Education Services: Program/Training Request Form
Thank you for your interest in a program or training hosted by Health Education Services!

Health Education Services (HES) offers health promotion and prevention programming, educational workshops, discussions, and trainings, and health communication campaigns for Georgetown students. HES also provides assessment, treatment, and/or referrals around the issues of body image, eating disorders, nutrition, substance abuse, stress management, sexual assault, relationship violence, stalking, pregnancy, and overall health and wellness. All clinical services are completely free and confidential.

Please fill out the request form below, and a HES staff member will respond as soon as possible. Requests must be submitted more than two weeks prior to the program. Requests received less than two weeks before the program date are not guaranteed.
Point of Contact: Name *
Your answer
Point of Contact: NetID *
Your answer
Organization, Club, or Office *
Your answer
Date and time of Program (If you do not have a specific date, please provide a general timeframe.) *
Your answer
Time and Length of Program (Please note that programs must be at least 30 minutes) *
Your answer
What subject(s) will the program cover? (Check all that apply.) *
Required
Number of Participants
Your answer
Demographic of Participants (Check all that apply.) *
Required
Do you have room reservations? *
Is there anything you would like us to know about your organization, club, or office?
Your answer
Do you have a preferred presenter? (Check all that apply.) *
Required
Is there anything else you would like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Georgetown University. Report Abuse - Terms of Service