Clone of Health Education Program Request

Department of Wellness

Health Education Program Request - Fall 2026
A seperate request must be completed for each presentation date, course section, and/or presentation topic.
Program Contact

First NameLast Name
Contact E-mail
Contact Phone Number

Area CodePhone Number
Organization/ Group/ Event Type

Other
If you are looking to request a program for either faculty or staff, please visit https://wellness.okstate.edu/employee-wellness/wellness-workshops.html or contact the Coordinator of Employee Wellness @nina.rankin@okstate.edu
Academic Course Type
Course Prefix ex. CPSY
Course Number ex. 3440
Organization/Group/Event Name
Please give us at least 2 weeks' notice before the requested date
Program Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearPriority request date
Program Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearAlternate request date
Program Start Time

:HourMinutesAM/PM Option
Program Duration
in minutes
Most of our programs range between 30 - 50 minutes depending on what topic is selected
Program Location

Other
Location Address
For Residential Life requests, you must have an estimated number of attendees greater than 10. You will be required to give us a headcount 24 hours prior to the confirmed program time. We cannot present to groups of less than 10 attendees. We recommend partnering with other CMs/Floors in your hall to increase attendance
Estimated Number of Attendees
Type of Program Requested

Other
You may request a program topic not listed above and for other durations and we will do our best to accommodate your request.
Program Areas

Other
Mental Health Presentation Choices:

Other
Physical Health Presentation Choices:

Other
Substance Abuse Presentation Choices:

Other
Should be Empty:

Department of Wellness