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
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms