Student Health Advocate Workshop Request Form
The Student Health Advocates are an integral part of the Health Promotion Services department at UC San Diego. They facilitate a number of FREE educational workshops on a variety of health and wellness topics for the UC San Diego community. These specific workshops are best suited for an indoor setting, with an audience of less than 50 people, and with participants who are expected to stay for the complete duration of the workshop.

Please note that the date of your requested workshop must be at least 2 weeks from today.
Contact Person *
Please include your first and last name.
Your answer
Organization or Department Name *
RAs/HAs: Please indicate your college or area (The Village).
Your answer
Phone Number *
xxx-xxx-xxxx
Your answer
Email Address *
Your answer
Location of the Workshop *
Please include the building name, room number or name, and any other applicable information.
Your answer
Number of Participants Expected *
Please note that we require at least 10 students to be in attendance.
Your answer
Please briefly describe the participants. *
Example: First year residents, student org members, etc.
Your answer
Workshop *
Please select the workshop that you would like the SHAs to facilitate for your group. All of our workshops are interactive.
What is the desired length of the workshop? *
Preferred Date & Time *
Please indicate your preferred date & start time for the workshop. Your requested date must be at least 2 weeks from today.
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Alternate Date & Time *
Please indicate your alternate date & start time for the workshop. This date & time will be used if your preferred date & time is unavailable.
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Additional Comments / Special Requests
Your answer
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