Well-Being Program Request

Benefits and Wellness Request Form for Onsite Seminars or Programs

Visit us online at www.nova.edu/hr/wellness

Please answer all of the questions listed below so that we may review your request for an onsite Well-Being Seminar or Program. If additional information is required, a member of our team will contact you at the email address or telephone number provided below.

College or Department Name:
Name of Person Making the Request:
Telephone Number:
NSU Email Address:
*Is this a request for an onsite health fair?
Select a Presentation or Program Topic:
*Other Seminar or Program Explanation:
*Date You Are Planning to Sponsor the Event:
Time You Are Planning to Sponsor the Event:
Anticipated Number of Attendees: