Prevention and Wellness Services Program Request Form

Thank you for your interest in PWS programs and services! For general inquiries, please call 360-650-2993 or email

Our staff and peer health educators are available to provide a variety of programs and guest speaker presentations to help promote health and wellness here at Western. To make a request, please complete all sections of this form (as applicable) – the more information provided, the easier it will be to follow up on your request.

We ask for a minimum of 2 weeks advance notice to schedule any of our core programs that are packaged and ready (i.e. Cookies & Condoms, etc.). More time may be needed to prepare programs on other topics or that require customization to meet your group’s needs, including developing graphics andpromotional materials. We will work with you to fulfill your request as soon as possible!


Please note: PWS can provide promotional materials for select programs that can be utilized for print and social media, but generally relies on the requestor to handle program promotion efforts with the intended audience.