Event/Program Request Form 🎉✨
Please complete this form to submit your event/program details.
Name of Student Organization Hosting the Event/Program
*
Name of Contact
*
First Name
Last Name
Contact Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Has the student organization Advisor approved this event/program?
*
Yes
No
Collaborating Organization (or enter 'No other org')
*
What type of event is this?
*
Fundraiser
Community Service
Professional Development
Student Organization Meeting
Other
Date of Event/Program
*
 -
Month
 -
Day
Year
Date
Start Time
*
Hour Minutes
AM
PM
AM/PM Option
End Time
*
Hour Minutes
AM
PM
AM/PM Option
Event Format
*
In-person
Virtual
Both
Learning outcomes/purpose of the event/program and what students will gain (skills, knowledge, etc.)
*
Please select the target population for this event.
You may select more than one option.
Target Population:
Any Rutgers School of Health Professions Student
Any Rutgers SHP Piscataway Student
Any Rutgers SHP Newark Student
Any Student Organization Member
B.S. Cardiovascular Sonography Students
B.S. Diagnostic Medical Sonography Students
B.S. Health Information Management Students
B.S. Occupational Therapy Students
B.S. Psychiatric Rehabilitation & Psychology Students
M.S. Clinical Laboratory Science Students
M.S. Clinical Nutrition Students
M.S. Clinical Research Management Students
M.S. Cytopathology Students
M.S. Healthcare Management Students
M.S. Health Informatics Students
M.S. Physician Assistant Students
M.S. Rehabilitation Counseling Students
M.S. Speech Language Pathology Students
Doctoral Clinical Laboratory Science Students
Doctoral Clinical Nutrition Students
Doctoral Occupational Therapy Students
Doctoral Physical Therapy Students
Doctoral Psychiatric Rehabilitation
Other
Estimated number of attendees
*
Goals of the Program
*
Any other details needed
Upload a flyer for your event/program
Browse Files
Drag and drop files here
Choose a file
File types: pdf, doc, docx, jpg, jpeg, png, gif
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Would you need Student Success to order food for this event/program? (this would be utilizing your student organizations allotted funds)
*
Yes
No
Catering
Food Preference
Would you need Student Success to order supplies for this event/program? (this would be utilizing your student organizations allotted funds)
*
Yes
No
Total budget for food and/or supplies (in USD)
*
Would you need Student Success to reserve a room for this event/program?
*
Yes
No
Please indicate Room support needed:
IT Support
Music
Photography
Laptops,
Projectors
TV(s)
Submit
Should be Empty: