Health Promotion Program Interest Form
This survey is to collect contact information from students who are interested in participating in the Health Promotion Program.

Note: Filling out this survey is not a commitment to participate.
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Name *
Email *
Phone Number *
Program and Graduation Year (ex. MD 2027, OT 2026, etc.) *
Monday August 28 
In person practice of motivational interviewing in the SIM Center Exam Rooms - MANDATORY 


(email Emilee if you absolutely cannot make one of these times work)
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