Program Request Form

Please fill out the form completely, press "Submit" at the bottom, and someone from our office will be in contact with you within a few business days.

If you have any questions please contact the Student Wellness Programs office at (989) 964-4658 or email us at healthed@svsu.edu

1. Today's Date

2. Name

3. Name of RSO/Campus Group

4. Email This question requires a valid email address.

5. Contact Number

7. Type of Presentation Being Requested

8. Date Requesting This question requires a valid date format of MM/DD/YYYY.

calendar

9. Time of Program

10. Location of Program

11. Number of People Attending

12. Any additional information we should know about

Please give a two to four week notice if you would like
Peer Health Education to facilitate the program.