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Health Promotion & Wellness Services Peer Education Presentation Request Form
PLEASE NOTE: IN ORDER TO BEST PREPARE AND TRAIN OUR PEER EDUCATORS, WE WILL NOT BE ACCEPTING ANY PRESENTATION REQUESTS SCHEDULED BEFORE SEPTEMBER 17TH.

We ask that requests be made AT LEAST 2 WEEKS prior to the date of the desired presentation. It may take up to 2 weeks for us to process, staff, and confirm your request.

Program Request Information
For more detailed descriptions of each peer presentation, please visit: http://health.umd.edu/peerpresentations.

Please note:
*To request Eating Your Way Through College (Presented by SNAPS), please email jjakubcz@umd.edu.
*For a general Health Center overview presentation, please contact argentin@umd.edu.

Peer Program Requested *
First Choice Date and Time *
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Time
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Second Choice Date and Time *
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YYYY
Time
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Location/Building Name *
Your answer
Room # *
Your answer
Some programs require techology. What best describes the technology in your classroom/space? *
If the program you requested requires technology and you do not have it avaialble, the program coordinator will work with you to accomodate your needs.
Contact Information
Preferred Name *
Your answer
Preferred Phone *
Your answer
Alternative Phone
Your answer
Email *
Your answer
How did you hear about us?
Your answer
Group Information
Name of Group, Class, or Residence Hall *
Your answer
Audience Size *
Must be at least 10
Your answer
Short description of audience *
Your answer
Program goals (i.e. what does your group hope to gain from this presentation?) *
Your answer
Will the instructor/group leader be present for the presentation? *
We strive to create accessible spaces during all of our presentations. Please let us know of specific accommodations your class, group, or residence hall may need to succeed.
Your answer
Other /Special Instructions
Your answer
Which of the following best describes you/your group? *
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