University Health Center Special Event Request Form

University of Maryland organizations and groups may request the University Health Center to partner, sponsor, or co-sponsor their campus health and wellness related programs, projects, campaigns, or events. In order to receive priority, please submit your request 1 month in advance.

What department or organization do you represent?
Please select the topic areas desired.
Event/Program Information
Please provide the following information about your event. All events must be aligned with the University Health Center mission and goals (www.health.umd.edu/about/mission); we reserve the right to refuse partnership if these requirements are not met.
Please describe why you are doing this event/program.
Has this program been proven to be successful and/or result in positive changes in behavior?
:
:
Monetary or resources requested
List all confirmed and invited partners and groups who may help with your event/program. Also include those you may solicit prizes and giveaways from.
How do you intend to evaluate the effectiveness of your program? Please describe and/or submit a sample evaluation form.
Evaluation Needs
Within 30 days of the event/program we would like a summary of the evaluation results (or a brief explanation of why you believe your event was effective) and the number of people who attended.
If available please provide a website address that provides details for this event/program/project.
CAPTCHA
This question is to make sure you are a human visitor and to prevent spam. This validation is case sensitive.
4 + 6 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.