Alice! Health Promotion

Stressbusters

Stressbusters Request Form

IMPORTANT: * indicates required field 

In order to best accommodate your event, we ask that requests be submitted at least two weeks before the scheduled event. We will try our best to fill your request, but please note that Stressbusters events are limited to two events per day. If we are able to fill your request, you will receive a confirmation at least five (5) days prior to the scheduled event.

Your Information

Name: *

Title:

Organization: *

Campus Email: *

Campus Telephone: *

Event Time and Place

Date: *

monthMonthJanFebMarAprMayJunJulAugSepOctNovDec

dayDay12345678910111213141516171819202122232425262728293031

yearYear200020012002200320042005200620072008200920102011201220132014201520162017201820192020

Preferred Start Time: *

hourhour123456789101112

:

minuteminutes00153045

am

pm

Preferred End Time: *

hourhour123456789101112

:

minuteminutes00153045

am

pm

Is your event open to the Columbia community and would you want Stressbusters to electronically advertise the event? :

Yes

No

Location: *

Expected Number of Attendees*

Number 0f attendees: *

1-25

25-50

51-75

75+

Type of Event *

Event Type: *

Residence Hall Floor Event

Student Organization Information Health Fair

CU Staff Event

Other

If other, please explain:

Additional Comments

Comments:

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