Wellness State

Freshman Orientation Program Request Form

Name of Instructor:
College:

E-mail Address:

Course Location:

Campus Phone:

Course Day and Time:

Campus Address:

Section Number:


Presentation Topics

Alcohol Education
Sexual Health
Tobacco
Nutrition
Physical Activity
Safety
Eating Disorders/Body Image
Stress Management


List the topics you would like to have presented in your classroom along with requested dates. You may select as many topics as you would like to have presented. You will be contacted prior to the beginning of the semester for confirmation.

      Topic

      Date - First Choice

      Date - Second Choice


If you have any questions, feel free to contact 744-3997

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