Wellness Resource Center: Program Request Form
Please fill out the following information. We require requests to be submitted at least 2 weeks prior to the date of the program (and at least 4 weeks for customized programming). If you have any questions, contact us at tuHEART@temple.edu or call 215-204-8436.

Cancellation Policy: Please note that we will do our best to accommodate your schedule, and we ask that you be respectful of ours in return. In the event of a scheduling conflict or change in plans, we request that you give us 24 hours notice.

Name
Your answer
Email Address:
Your answer
Department or Student Organization:
Your answer
Is this an FYE Course?
Provide 2 dates that would work for your program. (*Note that we require 2 weeks notice for regular programming and 4 weeks for customized programming.*)
Your answer
Time(s)
Your answer
Number of anticipated attendees:
Your answer
Location:
Your answer
Program(s) you are interested in:
Reason for Requesting the Program
Your answer
Any other information you would like to share?
Your answer
Submit
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