PEER EDUCATION PROGRAMPRESENTATION REQUEST FORM

  • If you are interested in requesting the services of our Peer Educators to provide a program/presentation, please fill out this form and submit your request at least one (1) week in advance.  Thank You!

    Name:

    UMES Dept.

    Email:

    Phone #:

    Program Date:

    Program Topic:

    Location:

    Start Time:

    End Time: 

    # Attending:

    Additional Requests: