Wellness Presentation Form

If you are interested in educational programs from the Campus Rec & Wellness student Wellness Ambassadors, please fill out the form below and hit submit at the bottom.

Group Information

Group Name

Type of Group

Group Size

Primary Contact’s Information

Name:

Email:

Phone Number:

Presentation Request (s)

Day, Date and & Time
- List the day, date and time you would like the presentation to be held.
- Please use one line for each individual presentation request.

Workshop Request 1:
Workshop Request 2:
Workshop Request 3:
Workshop Request 4:

Space Reservation Information

Have an on campus space reserved, please complete the following information:
Building Name/Field Space:
Room Number:
If you have requested multiple times and spaces are different for each time please note it here:

Have NOT reserved a space, please reserve an on campus space at least 48 hours prior to your scheduled workshop and notify Jayna Evans @ ext 2972 or jevans31@esu.edu. Please be sure the space reserved is large enough to accommodate your group.

If you are looking for Wellness Education and Prevention educational presentations, please contact Laura Suits at lsuits@esu.edu.

Additional Comments/Request

Please include any additional information you would like for us to know below.

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