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AWARE Program Request Form

Thank you for your interest in our AWAREness programs. You must complete all fields in order to submit your request. You will receive a confirmation message immediately after submitting your request. We ask for your patience as we transition to using the online program request service. If you do not get a response from a Health AWAREness staff member within 48 hours of your request, please contact health-awareness@iup.edu to confirm that your request was received. If you encounter issues while making your request online, you may contact health-awareness@iup.edu or call the Health AWAREness office at 724-357-4799.

 Booking an AWAREness program is easy! Just complete the form below.

All fields are required except where otherwise indicated.

Program Request

Please check the program name

Health AWAREness Haven Project Women's Programs
   


 


 [None] Select a Date Delete the Date  


 


 


 


 

Contact Information

 

 


 


 

Upon completion of this form, you will receive a confirmation that your request has been sent. A program request does not guarantee a reservation. Two weeks notice is generally required when requesting a program. A representative from the Health AWAREness office will contact you within 48 hours to finalize reservations. We reserve the right to refuse a request.

 

  • Health AWAREness
  • Suites on Maple East
    Suite G-59
    901 Maple Street
    Indiana, PA 15705
  • Phone: 724-357-4799
  • Fax: 724-357-4457
  • Office Hours
  • Monday through Friday
  • 8:00 a.m. – 12:00 p.m.
  • 1:00 p.m. – 4:30 p.m.