Wellness Presentation Request Form

The Office of Work/Life develops and delivers departmental, school-wide, or building-wide wellness workshops, programs, and initiatives.

Please complete this form so that we can gather more information. We will contact you within 10 business days to review your request in more detail.

Note: Please complete this form at least 30 days in advance of your desired date.

Type

Subtype

Requestor’s Contact Information

Name

UNI

Email

Phone

Role of Requestor

School or Division

Presentation/Event Information

University Role(s) of Attendees

Number of Participants Expected

Preferred Location of Presentation

Please note: The requesting school/department is responsible for securing space.

Has the Office of Work/Life presented to this group or delivered programs in the past?

If yes, when?

Are there Wellness topic areas that are of particular interest to your group?

Other (Please Specify)

Please list three proposed dates and times for the presentation

Date/Time 1st Choice

Date/Time 2nd Choice

Date/Time 3rd Choice

Phone