Wellness Executive Council

Proposed Program Title:

Peer Health Organization:

Coordinating Student/Committee:

Contact E-mail:

Contact Phone:

Is this a new program, or a continued one?

New Program

Continued/Annual

Program Focus:
(Check all that apply.)

Stress and Depression
Drug Use and Addiction
Suicide
Sexual Health
Sexual Assault
Sleep
Physical Fitness and Exercise
Illness and Self-Care
Nutrition and Disordered Eating

Environmental Health
Spirituality
Relationships
Peer Theatre
Tobacco
Other Health Issue:

Program Description (should be 125 words of less, if recurring program include description of past event/success):

What are your program's key points and learning objectives?

When? (what dates and times are associated with this event)

Where? (location as well as whether reservations are required)

How many expected to attend?

What resources (if any) are required? (include any requests for audiovisual equipment, Wellness Center resources, as well as support from other students or staff)

What is the budget for this program, and what will be purchased?

Total Amount Budgeted or Requested: $

What type of program evaluation(s) will be used? (sign-in sheet, survey, email follow up, etc)

Program Title:

Peer Health Organization

CAC

CAPP

Health Reps

Evaluator (your name):

Your E-mail:

Did this program occur according to plan with respect to date, time and location? Please explain:

What kind of marketing was used for this program? Was it effective?

How many students attended?

What was purchased for this program/event? (If you are requesting reimbursement you will need to submit reciepts.)

Total: $

What was the level of participant satisfaction with this program? Please explain:

Were your planned learning objectives achieved? Please explain:

Was an evaluation (survey, e-mail follow up, quiz, etc.) used as planned? Please explain:

What notes or suggestions would you have for future planners of this program?