Health Education/Outreach Request

In our Health Promotion programs, trained health educators collaborate with partners throughout the community, such as work sites, schools, faith based community groups, and families to promote healthy lifestyles.

The Health Promotion staff is committed to educating the community about how our individual choices affect our health and the environment. With advanced notice (at least one month), we will be happy to come to your location to provide free or reduced priced programs and presentations that support health enhancing behaviors.

Programs & Services

  • Car Seat Inspections and Injury Prevention Education
  • Asthma Awareness
  • HIV, Syphilis, and Hepatitis C Testing Outreach
  • Pregnancy Prevention and STD Education
  • Tobacco Prevention and Control
  • Nutrition and Physical Activity Programs
  • Policy Development Assistance
  • General Health Education

If you would like a one time presentation or ongoing program tailored to  your classroom, resource fair, employee fair, student organization, or church group, please complete the Health Promotion Outreach Request form below.

Requests must be submitted at least one month in advance of requested date to receive full consideration.

To download a PDF version of this form click here.

Request an Outreach Event

  • Contact Information

  • Contact Information

  • Audience Information

  • Services Requested

  • Event or Presentation Information

  • :
  • :

  • Health Topics of Interest

  • Equipment to be Provided by Event Organizer

  • Advertising Information

  • Drop files here or
    Accepted file types: jpg, gif, png, pdf, doc, docx, ppt.
    A maximum of 5 files may be uploaded.

  • Additional Information

  • Continuing Wellness Activities

    In order to continue the wellness of participants after your event, we encourage you to implement a policy or a change in your physical environment that can enhance your work site, office, etc. Listed below are examples of some changes you may want to adapt after the event. Please check the applicable boxes or list other changes you are interested in making in your organization.

  • Outreach Site Selection Policy

    1. - Event requests must be made in writing at least one month in advance.
    2. - Services offered will be mutually agreed upon and confirmed prior to the event.
    3. - Services offered may vary depending on the event and availability of equipment and supplies.
    4. - The Health Department's participation is dependent on the availability of Health Department staff.

    Please note: submission of this form does not constitute a confirmation of the Health Department's participation in your event. A Health Department staff member will contact you to discuss your event or presentation request, and the availability of staff for your event.

  • This field is for validation purposes and should be left unchanged.
Health: 2029 S. 17th Street • Wilmington, NC 28401 • Phone 910-798-6500 • Fax 910-341-4146 • Medical Records Fax 910-772-7805
Environmental Health: 230 Government Center Drive, Suite 140 • Wilmington, NC 28403 • Phone 910-798-6667 • Fax 910-798-7815