UTHSC Event/Service Request Form
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Thank you for your interest in working with UTHSC to improve our communities. Please use the form below to request community or volunteer services. If you have any additional questions or need assistance with this form, please call the Office of Health Disparities Education and Community Engagement at 901.448.3415 or qep@uthsc.edu. Please note that we receive more requests than we can fulfill. Submitting this form is not a guarantee of services. Please allow 48 business hours for a response to your request. 

Date of Proposed Event
Event Location 
Target Audience (ages, language, at-risk populations)
Estimated Number of Attendees
Services Requested
Contact Information
Any additional information
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