Healthy Workers Program
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Class Request Form

Name: Today's Date:
E-mail: Telephone:
Department: HWP Other

Class Information:
Topic(s):
Breast Cancer & Self-Exams
Dental Care
Cervical Cancer & Pap
Cholesterol & Triglycerides
Contraceptive Methods
Diabetes Prevention
Men's Health, Testicular Cancer & Self-exams
Sexually Transmitted Diseases
 
Class Date: Time:
Number of attendees: Location: Health Center
Language:
English Spanish
  Building & Room:

   

University Health Center

Healthy Workers Program
University Health Center, Room 1166
Campus Drive, Building #140
College Park, Maryland 20742