Skip survey header

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
This question requires a valid email address.
6. Subject Requested
This question requires a valid date format of MM/DD/YYYY.
Please give a two to four week notice if you would like
Peer Health Education to facilitate the program.