WesWell Program Request
If you are interested in having a health education program presented by the staff of WesWell, please complete all information below. Please attempt to submit your request at least three weeks in advance to ensure your preferred date and time.

►Visit Programming Considerations for suggestions on planning a program.
 
Contact Person  

Name

Email

Telephone

Residence Life Staff members:
If you are requesting this program for your residents, indicate which hall/house(s) will be invited.
Student Organizations:
If you are requesting this program on behalf of a student organization, indicate which group(s).
   
Program Information  
I am interested in the following program:

(click here to read program descriptions)




 
If the topic you are interested in is not listed above, please describe it here. 
Please be as specific as possible, e.g. "Addressing Alcohol Poisoning" rather than "Alcohol".
 

 
Describe the Intended Audience
Please describe who will be invited to attend this program.
 

 
Are there any specific aspects of this topic you wish to have addressed for this audience?

 

Approximate number of people expected to attend

   
Program Scheduling  

First choice of Date

 

Second choice of Date

Preferred Start Time (specify AM or PM)

 

Program Location
Any other information that could be helpful or that doesn't fit into the above categories?

 
You will be contacted within on week to discuss your program request in more detail.

If you wish to cancel or change your request, please email weswell@wesleyan.edu or call 860.685.2466 as soon as possible.  Thank you!

   

revised 10/11/2011