Skip to navigation
Skip to main content
Skip to footer
About
Academics
Admission and Aid
Student Life
Research
Athletics
My UM
Alumni
UM
Curry Health Center
Wellness
PROgramming_request_form
Curry Health Center
Site Navigation
Site Navigation
Home
Medical
Wellness
Pharmacy
Hours/Contact
Counseling
Health Portal
New Students
About Curry Health Center
Dental
Insurance
Forms
Wellness
Section Sidebar Navigation
Mission
Outreach
Wellness Events
Wellbeing Support Coordinators
Services
Request a Wellness Program
Well Being in Classroom
Get Involved
Support Wellness
National College Health Assessment (NCHA)
PROgramming Request Form
Your Name
*
Today's Date
*
Month
--
January
February
March
April
May
June
July
August
September
October
November
December
Day
--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
--
2020
2021
2022
2023
2024
2025
2026
2027
2028
Your Email
*
Contact Phone Number
*
Requested Program Name
*
Mental Well-Being
Stress & Resiliency
Substance Abuse Prevention
Healthy Lifestyle
Other Program
If you selected Other under Requested Program Name - please indicate what you would like
How long would you like this presentation to be?
-- Make a selection --
10min
20min
45min
60min
What delivery method would you like for your program
-- Make a selection --
Interactive power point format
Interactive led discussion with slide visuals
Interactive discussion
Is there certain aspects of the program that you would like to be focused on?
Requested Program Date (please allow at least two weeks notice)
*
Month
--
January
February
March
April
May
June
July
August
September
October
November
December
Day
--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
--
2020
2021
2022
2023
2024
2025
2026
2027
2028
Requested Program Time
*
Hour
--
1
2
3
4
5
6
7
8
9
10
11
12
Minute
--
00
15
30
45
AM/PM
--
AM
PM
Requested Program Preference
*
-- Make a selection --
In-Person
Virtual
Who is requested program for (department, student group, class, etc.)
*
How many will be attending requested program?
*
Requested Program Location (building on campus, Zoom, etc.)
* indicates a required field
Launch UM virtual tour.