HealthyUNCG | HealthyUNCG Program Request

HealthyUNCG Program Request

Program Request Form

Thank you for your interest in bringing wellness programming to your department! Please complete the form below, and a member of the HealthyUNCG team will follow up with you.

Name(Required)

FIRST LAST

UNCG EMAIL(Required)

PHONE NUMBER

DEPARTMENT AND OFFICE NUMBER(Required)

VIRTUAL OR IN-PERSON PROGRAM(Required)

Virtual

In Person

LOCATION OF PROGRAM

DESCRIPTION/TYPE OF PROGRAM REQUESTED(Required)

Date/Time Requested(Required)

Number of people expected(Required)