Project Health Program Requests
Please fill out the information below and we will get back to you as soon as possible! For additional inquires please email us at or call us at 205-348-3878.

Please note: The availability of peer health educators to present programs may be limited based upon the date and type of program requested, therefore we require that program requests are submitted at least two weeks (14 days) in advance.

Email address *
Name of Requestor *
Your answer
Title of Requestor *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Desired Date of Program *
Programs must be requested at least two weeks in advance. Due to the academic schedules of our interns, Project Health cannot guarantee the fulfillment of program requests for Spring semester dates beyond Thursday, 4/16.
Desired Time of Program *
What type of group is this program for? *
Where would program take place? *
Please provide the building and room number.
Your answer
Estimated audience size? *
Your answer
Which program would you like to request? *
Please reference for a complete list of presentations.
Do you need the program customized at all?
Please note: Project Health is unable to provide perishable items (food, drink, etc.) beyond what is already necessary for the program.
Your answer
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