UR Medicine / Employee Assistance Program / Workshops / Workshop/Training Request Form

Workshop Request Form

Please provide four weeks' notice for workshop requests. Any requests received less than four weeks before the requested date cannot be guaranteed. When an EAP counselor is assigned to a workshop, he/she/they will reach out to the requester no less than 24 hours in advance of the workshop time to finalize the number of attendees and the contents of the workshop.

place field "Organization" below

Organization Information

Organization

UR/URMC Other

place field "CompanyName" below

Presentation Location

place field "Directions" below

Directions to Organization

place field "ContactName" below

Contact Information

Contact Name

place field "ContactPhone" below

Contact Phone Number

place field "ContactEmail" below

Contact Email Address

place field "DateTime" below

Workshop Details

Employee Workshops

Please do not select an Employee workshop if another workshop has already been selected below.

Supervisor Workshops

Please do not select a Supervisor workshop if another workshop has already been selected.

Financial Workshops

Please do not select a Financial workshop if a another workshop has already been selected above.

Requested Date/Time of Workshop (Please Allow 30 Days Notice)

Please enter the time in XX:XX AM/PM format.

place field "DatesTimes" below

Alternative Date(s)/Time(s)

place field "EmployeeSupervisor" below

Workshop Audience

Employees Supervisors

place field "Topic" below

Reason for Workshop/Desired Outcomes

place field "NumberAttendees" below

Number of Attendees

place field "Mandatory" below

Mandatory for Staff

Yes No

place field "StaffNotification" below

Method for Staff Notification

place field "Equipment" below

Equipment Needed

No Equipment Needed Laptop Projector Other

Other Equipment

Please list or describe.

place field "EquipmentOther" below

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