You must have JavaScript enabled to use this form. Please submit your request with 4 weeks’ notice. We will do our best to accommodate late requests. Name CSUSB Department/Org/Club Email Phone number Checkout Kits: Checkout Kits: - None -Pour Me A Drink (alcohol use education)Create My Plate (nutrition / portion sizes)Self-massage and meditation kitCondom Condom Blastoff! (Condom proficiency)Other… Enter other… Event Date: Start Time: End Time: Event Location: Audience Members (select all that apply) Student Staff Faculty Approximate number of attendees Type of Request SHC overview presentation Health Workshop/Presentation Tabling Outreach Other Enter other… If selecting a workshop, please select a topic Stress Management Sleep Alcohol Moderation, and Safety Marijuana Basics Sexual Health (Safe Sex Practices, Birth Control, etc.) Other Enter other…