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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.

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Point of Contact: Name *
Point of Contact: NetID *
Organization, Club, or Office *
Date and time of Program (If you do not have a specific date, please provide a general timeframe.) *
Time and Length of Program (Please note that programs must be at least 30 minutes) *
What subject(s) will the program cover? (Check all that apply.) *
Required
Number of Participants
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?
Do you have a preferred presenter? (Check all that apply.) *
Required
Is there anything else you would like us to know?
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