First Name *

Last Name *

Email *

Phone *

Requesting Group *

How can we help? *
Health Promotion Presentation
WIT Cart at Your Event
Violence Prevention Program (training, presentation, etc)
Not listed Please specify a value for How can we help?

Name of Event *

Please provide a brief description of the event. *

Date of Event *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Time of Event *
- 1 2 3 4 5 6 7 8 9 10 11 12 Time of Event Minute - 00 15 30 45 Is Time of Event AM or PM - AM PM

Location of Event *

Expected Number of Attendees *

• Requests for outreach programming should be made no less than 3 weeks prior to the date of the proposed outreach program. Requests submitted less than 3 weeks notice may be denied, however exceptions may be made based on the event request.  
• It is the responsibility of the requesting person/s or organization/s to secure the location for the proposed program. Technology may be required based on the request. Any cost associated with the program (technology, location, etc.) is the responsibility of the requesting group or individual.
• Marketing and promotion of the requested program or service is the responsibility of the requesting group. It is furthermore the responsibility of the requesting individual to remain at the event throughout the program. This may include providing access to the room or building at least 10 minutes prior to the scheduled start time, greeting students, assisting with set-up, participant sign in, passing out evaluations, etc. 
• Program requests are scheduled for 1 hour unless otherwise agreed. 
• University Health and Well-being reserved the right to decline requests if the content being requested does not meet the mission of University Health and Well-being, GVSU or competes with an already existing University Health and Well-being program of similar topic.  Events may be cancelled at the discretion of University Health and Well-being staff due to unforeseen staffing situations, weather, space or other conflicting reasons. 
• Additional costs may be associated with the event based on the request, for which notice will be provided in advance. Examples may include, travel costs, additional staff, grocery expenses for cooking demos etc,. 
• It is at the discretion of the University Health and Well-being staff if the event needs to be cancelled due to low attendance. 

Have you read the above guidelines? *
- Select Option Yes No