Media/information request
For Internal/MRU Student Use Only

**Please note:
Wellness Services staff are primarily focused on supporting the clinical and wellbeing needs of the MRU community. Not all media or information requests will be accommodated. Requests will be considered based on staff availability and alignment with service priorities.

Once a fully completed form is received, our team will review the request. If we are able to support it, you will be contacted within 72 hours to discuss next steps.

To maintain the privacy and confidentiality of clients and patients, video and/or audio recording devices are not permitted inside clinical spaces within our facilities.
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Expected publication/air/assignment due date? *
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Deadline for response (if applicable) *
MM
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YYYY
Meeting date request (include several times that you are available to meet ie. Mon 15th or Wed 17th 10:00am-11:00am) *
Your name *
Number of students attending? *
MRU Email *
Program of study *
Contact phone *
Interview category *
Select relevant box(es) below
What type of interview is being requested? *
Is there a specific unit in Wellness Services that is being requested? *
Project title *
Project description *
Give more detail below on what your project is and what information you require.
Primary objective/desired outcome of interview? *
Questions that will be asked during interview *
This will allow the interviewee to be prepared.  If your questions are not provided, an interview CAN NOT be arranged.
How long will the interview take (to accommodate busy/tight schedules of the interviewee)? *
How will the results of the interview be distributed? (e.g., Reflector, Calgary Journal, or class assignment?) *
Who referred you to Wellness Services for an interview/comment? *
Additional comments
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