Program Request Form

Check out the Health Promotion Program Menu and request a workshop or program for your student group/organization, classroom, or residence hall, please fill out and submit the form below.

Programs and workshops are lively and interactive. They include handouts and useful give-away items that serve as tools that facilitate students getting from just “knowing what to do” to taking action. (For example: sleep masks and nap-friendly snacks are part of the “Flash Nap” workshops.)  All programs are delivered in a critical thinking framework and include measurable Student Learning Outcomes (SLOs) that are associated with building resilience and wellbeing to support academic success.

Requests must be submitted at least two to three weeks in advance (depending on the season) of your desired program date.

Program/workshop sponsors (that's you) are responsible for advertising, room reservation and set-up, refreshments and attendance…let us know if you need assistance with getting those things done!

This form is not complete until all required fields are filled in.  If you see this page, your request has not been submitted.

($) indicates a fee for the program/ workshop.  Details will be provided when you submit the Program Request form below

Today's Date
Person #1 Requesting Program
Person #2 Requesting Program (RAs must include their HD)
Possible Date(s) for Presentation
Please indicate multiple dates if you have flexibility for scheduling.
1st Choice  
2nd Choice
//   :
3rd Choice
//   :
Program Selection
Context of Presentation?  

Location Logistics

Do you plan to serve food?  

Would you like guidance choosing what type of food to serve?  

If you have a problem with submitting this form, please call (502) 852-5429 OR e-mail

We look forward partnering with you to support the wellbeing and resilience of our campus community!