The Wellness Center, University of Cincinnati

University Health Services Wellness center

UC Wellness Center Program Request Contract

All fields required
Personal Information
Requested By:
Organization:
Phone Number:	() -
E-Mail Address:

Workshop Information
Topic:
Other:
Location of Workshop:
Approximate # of People:
Comments (optional):

First Choice:

Date (mm/dd/yyyy): // Time: :

Second Choice:

Date (mm/dd/yyyy): // Time: :

NOTE: By clicking I agree you acknowledge that you agree to meet with the Peer Educator conducting your workshop/ presentation prior to the date. This meeting is mandatory in order to confirm the date and topic you requested. In order for the workshop to be conducted there must be at least FOUR people in attendence (not including the R.A.). The program will be cancelled 10 minutes after the previously scheduled time if there are not enough people.

I agree

UC Wellness Center (e-mail link to Wellness.Center@uc.edu)
Steger Student Life Center Room 675
P.O. Box 210366
University of Cincinnati
Cincinnati, OH 45221-0366
Phone: 513-556-6124; Fax: 513-556-6077
Open: Monday-Friday 9 a.m.-5 p.m.