Eastern Illinois University :: Health Education Resource Center

91成人视频 Health Education Resource Center

If you are requesting a program for University Foundation courses, please do so using this link: /herc/machform/view.php?id=46276

H.E.R.C. Program Request Form

Note: Please place requests two weeks in advance to ensure availability of your program.

Name: Name: * First Last
Department/Organization: *
Campus Location/Address: *
Phone Number:
Email Address: *
Best Way to be Reached: *

Best Way to be Reached: Phone Email
Presentation Information
Presentation Topic: *
If you chose "other" above please provide a topic below.
Date of Presentation: Date of Presentation: * / MM / DD YYYY
Time of Presentation: Time of Presentation: * : HH MM AM/PM
Location of Presentation: *
Length Requested: *
Presentation Style: *

Presentation Style: Lecture Panel Discussion Other
If Other:
Technology Available: (Computer and Projector) *

Technology Available: (Computer and Projector) Yes No
Additional Comments:

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Eastern Illinois University is authorized to operate as a postsecondary educational institution by the Illinois Board of Higher Education.

91成人视频's programs, resources, and facilities are available to all students regardless of race, color, sex, religion, age, national origin, ancestry, marital status, disability, veteran status, sexual orientation, and/or gender identity. Discrimination precluded by federal and state statutes is strictly prohibited.

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91成人视频 Health Education Resource Center

H.E.R.C. Program Request Form

H.E.R.C. Program Request Form

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