Contact InfoDepartment/faculty/college/group:(Required) Name:(Required) First Last Position:(Required) Email:(Required) Dates & TimesPlease indicate your preferred date(s) and time(s) for this workshop. Requests for workshops and presentations must be submitted at least six weeks in advance. Date(Required) MM slash DD slash YYYY Time(Required) Hours : Minutes AM/PM AM PM AM/PM Date MM slash DD slash YYYY Time Hours : Minutes AM/PM AM PM AM/PM Date MM slash DD slash YYYY Time Hours : Minutes AM/PM AM PM AM/PM Are these dates and times flexible?(Required) Yes No Requested Workshop/PresentationRequested workshop/presentation:(Required)Health & Wellness Overview (30 minutes, unless otherwise requested)5 Ways to Wellbeing (1.5 hours)Identify, Assist Refer+ (IAR+) (Staff, faculty and student leaders only. Completion of IAR online training is a pre-requisite for participants) (2 hours)Peer Support Service Overview (10 minutes)LivingWorks START (Online Training) (1.5 hours)AudienceApproximate number of participants:(Required)Health & Wellness workshops are only provided to groups of 12 or more. Who is the target audience? Check all that apply:(Required) Undergraduate students First-year undergraduate students Upper-year undergraduate students Graduate students Prospective students International students Exchange students Staff Faculty Student staff Other If you selected "Other", please specify: Provide information about the group’s discipline/program and any other relevant information:LocationWill this workshop/presentation take place virtually or in-person?(Required) Virtual In-person If you selected "In-person", what is the location? Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Describe the location's set-up:E.g. classroom, lecture theatreIndicate which tools we will have access to:Check all that apply. Internet access (wired) Internet access (wireless) Fixed tables Moveable tables Whiteboard Chalkboard Flipchart easels Indicate which computer setup we will have access to: Teaching station (with built-in computer and projector) Teaching station and a laptop Laptop connected to projector Desktop computer connected to projector Check all that apply.Will you require Health & Wellness resources? (e.g. info cards, brochures, posters) Yes No Will breakfast/lunch/refreshments be provided? Yes No Additional InformationIs this workshop part of a larger program (e.g. club, conference, orientation)? If so, please explain:Please list any other partners involved: How did you learn about workshops provided by Health & Wellness? Would you like Health & Wellness to also promote the event to increase attendance? Yes No If there is anything else you would like to let us know, please include it below:Freedom of Information & Protection of PrivacyConsent(Required) I agree to the privacy policy.The University of Toronto respects your privacy. Personal information that you choose to provide voluntarily to the University is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose(s) of program administration. At all times it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please contact health.promotion@utoronto.ca.