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Health Promotion and Prevention Services Workshop Request Form

Thank you for your interest in hosting a Health Promotion and Prevention Services workshop. Please complete this form and a Health Promotion and Prevention Services Staff member will be in touch with you shortly. Please provide 2 dates and times you have available for your workshop.

If you are a Resident Assistant, marketing materials can be found on the Office of Residential Life & Learning Communities ANGEL page.

If you have any questions, please contact Health Promotion and Prevention Services at (585) 395-5599.

* Required

Name (First & Last) *

E-mail Address *

Phone Number *

Requested Date/Time #1 *

Requested Date/Time #2 *

Workshop Location *

Workshop Requested *
Please visit www.brockport.edu/hpps/workshoplist.html for workshop descriptions.

Additional Comments, Information, or Questions

Last Updated 10/5/10