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Student Health Advocate Tabling Request Form
The UC San Diego Student Health Advocates are available to table at your existing on-campus event on a variety of health and wellness topics (as staffing schedules allow).

Questions? Contact Erica Okamura, Program Director, at eokamura@ucsd.edu or 858.534.1824.

Contact Person *
Please include your first and last name
Your answer
Organization or Department Name *
Your answer
Phone Number *
(xxx-xxx-xxxx)
Your answer
Email Address *
Your answer
Location of the Tabling Event *
Please note we can only accommodate requests for on-campus events.
Your answer
Number of Participants Expected *
Your answer
Please briefly describe the participants. *
Example: First year residents, general UCSD student population, etc.
Your answer
Date of Tabling Event *
MM
/
DD
/
YYYY
Start Time of Tabling Event *
What time would you like the SHAs to start tabling at your event?
Time
:
End Time of Tabling Event *
What time would you like the SHAs to stop tabling at your event?
Time
:
Please describe the topic(s) you would like the Student Health Advocates to address at the table. *
Example: alcohol, drugs, sexual health, healthy eating, SHA Program promotion, etc.
Your answer
Additional Comments / Special Requests
Your answer
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