Wellness Outreach Request
Wellness Coordinators provide topic-specific outreach to SIU students, staff, and the local community. Programming can be tailored to meet the unique needs of the audience.
Name:
*
First Name
Last Name
E-mail
*
Phone Number
*
Affiliation to SIU:
Student
Staff/Faculty
Not Affiliated
Preferred Date of Presentation:
*
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Month
-
Day
Year
Date
Preferred Time of Presentation:
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Alternative Date:
-
Month
-
Day
Year
Date
Alternative Time of Presentation:
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Length of Presentation Time:
Example: 30 minutes, 45 minutes, 60 minutes etc.
Location of Presentation:
Please include the name of the building, department, and room number.
Please describe the topic(s) you would like presented upon:
Topic areas may include orientation to Student Health Services, physical, nutritional, and sexual health, alcohol and other drug harm reduction, violence and suicide prevention, stress management, resilience and coping skills, and healthy equity and inclusion.
Please describe the topic(s) you would like presented upon:
Stress Management
Student Health Services
Sexual Health
AOD
Violence Prevention
Nutrition
Physical Health
Other
Purpose of presentation/Desired Learning Outcome
Audience Description:
Undergraduate
Graduate Students
Staff/Faculty
Community
Expected Number of Participants:
10 - 20 people
21 - 30 people
31 - 50 people
51 - 75 people
More than 100 people
Other
Is there audio/visual equipment available at the location of the presentation?
*
Yes
No
Limited
I don't know
If yes, please describe what audio/visual equipment is available for the presenter at your location:
Tell us anything else we need to know:
Submit
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