Learning Activity Request Form

Contact Information

Name *

Department or Laboratory *

Phone Number (XXX-XXX-XXXX) *

Email Address please use your UCR email address *

Topic Requested

Most EH&S Instructor Lead learning activities range in length from 30 minutes to 2 hours. The length of activities resulting in a certification will vary depending on the topic and may be facilitated by an outside vendor.

Please select one the following EH&S topics. *

Please specify topic: *

List any additional topic(s) to cover, department specific learning needs, or department/job specific information to review.

Scheduling and Logistics

Indicate 3 dates and times when you would like this learning activity scheduled.

EH&S staff require a minimum of 7 business days notice for most Instructor-Lead learning activity requests. If there is a more immediate need, please complete this form and send an additional email to ehstraining@ucr.edu.

Date First Choice * +

Date Second Choice * +

Date Third Choice * +

Select a preferred start time range.
Trainigns are provided Monday - Friday. Certain topics require more time be scheduled and may adjust your preferred start time. Special dates and time requests should be emailed to ehstraining@ucr.edu *

9am-11am

1pm-4pm

Identify location. *

I do not have a location

I do have an onsite or booked location (specify below) I do have an onsite or booked location (specify below)

Number of participants. *

Provide any necessary additional Information.