Wellness Presentation Request Form

Reminders for requestors of education programs:

• Submit your request at least two weeks in advance
• Meet the presenter at least 10 minutes beforehand at the event location
• Have at least 10 attendees

Helpful hints to improve attendance at residence hall and student organization programs:

• Post fliers advertising the program
• Send out email reminders
• Provide incentives for the audience

Audience Description

Class Organization Residence Hall Greeks Information Table Other

Event/Class Name

Event/Class Name:

Sex of Group:

Male

Female

Both

Age/Year in School

Age/Year in School:

Expected Attendance

Expected Attendance:

Requested Topic

Requested Topic:

Contact Information

Contact person's name: Contact person's title:

Contact person's e-mail: Contact person's phone number:

Preferred method of contact:
Phone Email Both

Program Information

Location of Program: Preferred Date:

Preferred Time: Alternative Date:

Alternative Time:

Comments/Special Circumstances:

Equipment available at location:

Chalkboard
Computer
Dry Erase Board
LCD Projector
Overhead Projector
Paper & Easel
Projection Screen
VCR/TV

Requested Presenter:

First Available/No preference Peer Educator Graduate Intern Ashley Granger Julie Hupperich Hope McPhatter Kathy Saichuk Vanessa Richard

If you have any further questions or comments, please direct them to:

Julie Hupperich
Assistant Director
LSU Student Health Center
Suite 2, Phone: 225-578-5717