Program Request Form

All fields are required

Program Information

*Program or subject requested:
*First choice date & time:
*Second choice date & time:
*Location for program:

Group Information

*Group or Residence Hall:
*Expected audience size (must have at least 10):
*Short description of audience (male/female; year, etc.):

Contact Information

*Name:
*Phone:
*Email:

You will be contacted about your request as soon as possible. If you do not hear from someone within a week, please contact us at 681-WELL, option #4.

Reminders for requester:

• Need to have at least 10 in attendance
• Need to post fliers for event at least one week in advance
• Send out emails to residents
• Provide incentives for the audience
• Meet the presenter at least 5-10 minutes beforehand either in the commons room or outside the front door (especially if they don't have access)