HEALTH EDUCATION PROGRAMS Select a program topic. Please use one form per program. DIET/NUTRITION My Plate - Healthy Eating Nutritional Jeopardy Creating Healthy Meals Other: _______________________ PHYSICAL FITNESS Healthy Jeopardy Weight Loss Challenge Broncos Move More Other: _______________________ SEXUAL/REPRODUCTIVE HEALTH STI 101 Negotiating Safer Sex Sexual Health Jeopardy Other: _______________________ WELLNESS Dimensions of Wellness Mindfulness - Stress Reduction Wellness Assessments Other: _______________________ Personalized Program Idea: PLEASE DESCRIBE ANY ADDITIONAL INFORMATION YOU WOULD LIKE TO BE COVERED DURING THE PROGRAM: Return the completed form to: Letitia Johnson-Arnold , MS, CHES Medical and Health Program Consultant Fayetteville State University SHS USE ONLY Student Health Services Date received: Phone: (910) 672-2081 Date requestor contacted: Fax: (910) 672-1366 Date and time of scheduled program: Email:ljohns75@uncfsu.edu Date Confirmation Sent: Number of Actual Participants:
HEALTH EDUCATION PROGRAMS Select a program topic. Please use one form per program. DIET/NUTRITION My Plate - Healthy Eating Nutritional Jeopardy Creating Healthy Meals Other: _______________________ PHYSICAL FITNESS Healthy Jeopardy Weight Loss Challenge Broncos Move More Other: _______________________ SEXUAL/REPRODUCTIVE HEALTH STI 101 Negotiating Safer Sex Sexual Health Jeopardy Other: _______________________ WELLNESS Dimensions of Wellness Mindfulness - Stress Reduction Wellness Assessments Other: _______________________ Personalized Program Idea: PLEASE DESCRIBE ANY ADDITIONAL INFORMATION YOU WOULD LIKE TO BE COVERED DURING THE PROGRAM: Return the completed form to: SHS USE ONLY Date received: Date requestor contacted: Date and time of scheduled program: Date Confirmation Sent: Number of Actual Participants: Letitia Johnson-Arnold , MS, CHES Medical and Health Program Consultant Fayetteville State University Student Health Services Phone: (910) 672-2081 Fax: (910) 672-1366 Email:ljohns75@uncfsu.edu
Bronco%20Wellness%20Program%20Request%20Form.docx