Health Promotion & Education Event Request Form

Use this form to request a health-related workshop or other health-related event at Hunter.

Today's Date * / MM / DD YYYY
Name * First Last
Email *
Phone - ### - ### ####
Role at Hunter *
If you are faculty/staff, what is your department?
If you are a student, what club/group are you requesting this event for?
If applicable, what is your role in the club/group named above (e.g., president, member)?
Event Request Information

This is the description of your section break.
What type of event would you like to request (e.g., workshop)? *
When do you want this event to take place? *

Either put an exact date or time frame (e.g., October 2014)
What time do you want this event to take place? *

If you're unsure of the exact time you'd like to request for the event, put a general time frame or time of day (e.g., "between 9 & 11am" or "afternoon")
How long do you want the event to be (e.g., 1 hr, 1.5hrs)? *
Where would you like this event to take place? *

You can also indicate if you don't know.
What topic would you like the event to cover? *
If you selected "other" above, please list the topic of interest here:
Please explain why you are requesting this event: *
What involvement would you like Health Promotion & Education Staff to play in the event? *
If you chose "other" above, please explain: