Community Health Network Calendar Request

Name of Class

If the name of the organization hosting your class does not show in the list below, please contact [email protected] to have it added as a site.

Coordinating Agency

What organization is coordinating leaders/scheduling of class

Language

Last Date to Enroll

Start Date

End Date

Day of the Week

Start Time

ex: 2:30 pm

End Time

Number of Sessions

Worksite Classes Only

2nd Day of the Week

Start Time

ex: 2:30 pm

End Time

Start Date

Please enter the first date the class meets on the 2nd day of the week (for example, if class meets on Monday and Wednesday and Monday is 12/1, enter 12/3)

Is this class public or private?

PublicPrivate

If private, who is this workshop for?

Is there a fee to the participant?

YesNo

If yes, what is the cost to the participant?

Will the event be held:

In personVirtually

Additional Notes and Class Time exceptions

Presenter 1 Name

Presenter 2 Name

Class Location Information

Address Line 1

Address Line 2

City

State

Zip Code

Site Coordinator Contact Information

First Name

Last Name

Phone

Name of Organization

Name of organization the program is being held at

Session Information

Fill out date for each session of the class. To add a date use the add another session link below to the left.

Session Dates

Date

Community Health Network Calendar Request

Community Health Network Class Request Form