Clemson University Online Forms

Student Health Services Program Request Form

Program requests must be submitted at least 10 days in advance from the desired program date.

* Denotes a required field

Name *

First NameLast Name

Email *

name@example.com

Phone Number *

-- Ext.

Classification *

Student
Faculty
Staff

Other:

Organization/Department *


Please select the desired program module/presentation topic(s). A full description of each program module along with learning outcomes can be viewed by clicking "Program Module Descriptions" at the top of the Web page, above the form.

You may select more than one topic or program module if you would like us present on multiple topics. Please note that each module takes about 10 minutes. We can tailor a program/presentation based on the audience. If you'd like to request a Tigers Together Suicide Prevention Training, please click on the link at the top of this page, or visit clemson.edu/suicideprevention and click on "Get Involved."

If you would like us to present about a topic not found on this list, please specify in the "Other" box below.


Program Modules

Alcohol 101
Be a Man: Alcohol Effects on Men
Don’t Get Benched: The Impact of Pre-gaming and Tailgating
Game On! Alcohol Effects on Your Body
Girls Just Want to Have Fun: Alcohol Effects on Wo...
Just Like a Pill: Rx Misuse and Abuse
Life of the Party: How to Host a Safe Party
Marijuana 101: How are the mind and body affected?
Bringing Awareness to Eating Disorders
Depression and Anxiety
I Will Survive: Stress and Resilience
Dream On: The Importance of Sleep
An Orange A Day: Wellness and Body Image
Away We Go: Health and Wellness While Abroad
Eight Dimensions of Wellness
The Men’s Guide to Health
#GradLife: Health and Wellness for Graduate Students
There’s an App for That: Promoting Health Via Technology
Healthy Relationships and Interpersonal Violence Prevention
Sexual Responsibility: Let’s Talk about "IT"

Other Topic Not Listed Above


Length of Desired Program

Date of Desired Program

/ / (mm/dd/yyyy)

Time of Desired Program

:

Desired Location

Number of People Attending Program

Audience

Who would you like to attend, and would you like us to reach out to these other departments/organizations to see if they're available?

Clemson Bedsider-U (Sexual Health Student Organization)
Clemson University Police Department (CUPD)
Counseling and Psychological Services (CAPS) Provider
Medical Services Provider
Registered Dietitian from University Housing and Dining

Other:

Reason for Program Request

Additional Information