Peer Program Presentation Request Form: JADE - Fall 2019
JADE is a peer education program through University Counseling Services that conducts psycho-educational presentations in the area of disordered eating, eating disorder awareness, and body diversity. Topics in these presentations include, highlighting the types of eating disorders, health consequences, relevant statistics, myths and stigma surrounding eating disorders and disordered eating, and information on programs and resources specific to disordered eating and how to get help.

You will receive an email within a week of your request as confirmation.

For questions, please email Steven Wang (Peer Education Coordinator) at Steven.Wang@csun.edu
Email address *
First/Last Name of Peer Educator Generating Presentation (For Professors: Please mark: "N/A") *
Your answer
Person A (For Professors: Please mark: N/A) *
Your answer
Person B (For Professors: Please mark: N/A) *
Your answer
Day of Presentation (Please schedule presentation at least 7 days from today) *
MM
/
DD
/
YYYY
Time of Presentation (e.g. 8:30 AM) *
Time
:
Length of Presentation (e.g. 30 minutes - 1hr) *
Your answer
Professor's Name *
Your answer
Professor's Email Address (e.g. Matty.dor@csun.edu) *
Your answer
Course Number (e.g. Psych 321, Soc 1, etc.) *
Your answer
Class Size (e.g. 30 students) *
Your answer
Room Location (e.g. SH 214) *
Your answer
What technology is available? (e.g. Smart Room, Black Box access, etc.) *
Your answer
Additional Comments/Feedback? (If none, please mark: N/A)
Your answer
Thank you for scheduling a presentation with the JADE program! Within a week (usually within 72 hrs) of submitting your request, we will send you a confirmation email of your scheduled presentation with your request details.
A copy of your responses will be emailed to the address you provided.
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