Resource Request Form — Health Promotion - a division of Campus Health Services

Resource Request Form

To request resources for your student group/organization, classroom, or residence hall, please fill out and submit the form below. You will be contacted by a Campus Health Health Advocate Leader approximately two business days after submitting your request to confirm your submissions

1. If you would like to request a hand sanitizer pump for your office/department, please order through the UofL Stockroom by clicking HERE

2. If you would like to request a personal sexual health resources kit, please click HERE

Questions? Contact the Health Promotion Office at 502-852-5429 or email our service account.

Today's Date

Year/Month/Day

Person Requesting Resources

Name

E-Mail Address

Phone Number

Organization

Position

Other Position

Resources Choose the materials that you would like to request from the dropdown. (Anything with an asterisk (*): 3 maximum; more available upon making a Program Request.)

List other

Item Quantity

If Brochures/Educational Materials, what topic would you like these for?

Campus

Belknap
HSC
Shelby

Location

How will these resources be used?

Date/Time Needed

Year/Month/Day Hour:MinuteAM/PM