In-Class SDoH Request

100%

1.Thank you for your interest in requesting programming from the Office of Health Disparities Education and Community Engagement. Please fill out the information below to help us prepare for your request and we will reach out to you within 48 business hours to discuss details. If you have any challenges with this form, please reach out to Dr. Charles Snyder at [email protected].

Thank you!

2.Services Requested

In-Class Lecture or Workshop

In-Class guest speaker or panel

Support for course curriculum or material development

Service-Learning Activities

Other

3.Please provide details about what you would like to do

4.Have all students in this course already received an introduction to SDoH in this or previous courses?

5.What course is this for? Please include information to include program, class year, and course name.

6.Do you have specific scheduling needs or a timeline? Please provide details below

7.Please share your contact information below

First Name

Last Name

Phone

Email Address