Request edit access
Wellbeing Pop-In Services
If you are interested in having a member of the Health Promotion team at The Center For Student Health and Counseling or Campus Rec virtually come into your classroom to provide a Wellbeing Pop-In service for your students, please complete this form and someone from the department will be in touch to set up the service.
Sign in to Google to save your progress. Learn more
Which wellbeing topic would you like us to address with your students? *
Would you like your content to be done live (synchronous classes) or a pre-recorded video? *
NOTE: Stretching & Chair Yoga are currently only offered live and are subject to instructor availability.
What would you like your students to gain from this? *
Preferred Date: *
Use this to indicate your first choice.
MM
/
DD
/
YYYY
Time
:
Alternate Date: *
Use this to indicate the next best date if we are unable to accommodate the first.
MM
/
DD
/
YYYY
Time
:
How long would you like the Wellbeing Pop-In to last? *
Expected Number of Students *
Approximate number of participants:
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Portland State University.

Does this form look suspicious? Report