Center forHealthEducationandWellness
Complete and submit this form to request a CHEW staff or COPE/peer education program at least two weeks in advance of your desired program date. We will get back to you within five working days of your request. Thank you.
1. Select a presentation group:
COPE (all peer presentation)
ADAPT Alcohol and Drug Awareness Peer Team
PEACE Peer Education on AIDS and other STIs in a College Environment
SPARK Students Providing Assault and Relationship Knowledge
CHEW professional staff
2. Select a presentation topic:
Alcohol and other drugs
Healthy relationships
Sexually transmitted infections including HIV
Sexual assault
Stress and time management
Other (please specify)
3. In order of preference, what "two" optional dates and times would you like to hold the program?
First Choice
Second Choice
Date (mm/dd/yy)
Time (00:00 AM/PM)
4. For whom is the program being requested (group, class, etc.)?
5. How many attendees do you expect?
6. Where will the presentation be held (building and room #)
7. Please complete your contact information:
a. name
b. e-mail address
c. phone number
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