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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 two weeks in advance to ensure your preferred date and time.

►Visit Programs by Request for more program descriptions and information on presenters.
►Visit Programming Considerations for suggestions on planning a program.
 
Contact Person  

Name

Email

Telephone

Are you a Residence Life Staff member?      
If Yes, where do you live?
If No, leave blank.
   
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".
 

 
Presenter Preferred
Indicate who you would prefer to have present your program, if you have a preference.
 


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

 
Does the intended audience have any specific needs you can anticipate in regards to this health topic?

 

Approximate number of people expected to attend

   
Program Scheduling  

First choice of Date

 (specify month/day)

Second choice of Date

 (specify month/day)

Preferred Start Time

  (specify time and AM or PM)
Program Location

You will be contacted within 48 hours (except on weekends) to discuss your program request in more detail.

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

   

revised 12/05/2007