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: Alcohol Binge Drinking Tobacco Durgs Sexual Responsibility Sexually Transmitted Infections/Diseases HIV/AIDS Sexual Assault/Date Rape Other
Location:
Start Time: 5:00 pm 5:30 pm 6:00 pm 6:30 pm 7:00 pm 7:30 pm 8:00 pm
End Time: 6:00 pm 6:30 pm 7:00 pm 7:30 pm 8:00 pm 8:30 pm 9:00 pm
# Attending:
Additional Requests:
Alcohol and Drug Policy Smoking Policy Program Request Mocktail Bar Request AlcoholEdu Login