Peer Health Education Workshop Request Form
Submit this form to request a Peer Health Education workshop. All requests are tentative. Hosts will be contacted via email to confirm or seek alternative arrangements. Hosts are responsible for the following: room reservations (if needed), communicating any accessibility needs, promoting attendance, encouraging active and respectful participation.

Peer Health Education Workshops are facilitated by trained student volunteers. To better meet your needs, please make requests at least 3 weeks prior to the proposed workshop date.
Host Information
Please enter your contact information below.
Your Name *
Your answer
Phone Number *
Your answer
Email *
Your answer
Workshop Information
Group/Class Requesting Presentation *
Include 5 digit course code for classes
Your answer
Proposed Workshop Date: *
MM
/
DD
/
YYYY
Proposed START Time: *
Time
:
Proposed END Time: *
Time
:
Alternative Date & Time *
Your answer
Location of Workshop: *
Your answer
Anticipated # of Participants *
Most workshops are designed for a maximum of approx. 40 participants
Your answer
Which health topic are you interested in? *
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