{"id":4179,"date":"2025-08-07T14:22:24","date_gmt":"2025-08-07T19:22:24","guid":{"rendered":"https:\/\/uwm.edu\/wellness\/?page_id=4179"},"modified":"2026-03-26T12:03:32","modified_gmt":"2026-03-26T17:03:32","slug":"dcc-request-form","status":"publish","type":"page","link":"https:\/\/uwm.edu\/wellness\/health-promotion\/dont-cancel-class\/dcc-request-form\/","title":{"rendered":"Don&#8217;t Cancel Class Program Request"},"content":{"rendered":"\n<p>Thank you for not canceling class and providing your students with an opportunity for health education! Our programs can be done in a variety of formats and encourage self-awareness, empathy, skills building and an exchange of ideas. For more information, <a href=\"https:\/\/uwm.edu\/wellness\/health-promotion\/dont-cancel-class\">visit our don&#8217;t cancel class program page here.<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading hidden\" id=\"h-don-t-cancel-class-program-request-web-form\">Don&#8217;t Cancel Class Program Request Web Form<\/h2>\n\n\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Don&#8217;t Cancel Class Program Request Form<\/h2>\n                            <p class='gform_description'>Use this form to request Student Health and Wellness Center (SHAW) staff present a wellness program to your students.<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/wellness\/wp-json\/wp\/v2\/pages\/4179#gf_10' data-formid='10' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_aad7e94068a873bc06ed3ec27580d45f\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_aad7e94068a873bc06ed3ec27580d45f\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_10' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>3<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_33' style='width:33%;'><span>33%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_10_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_50\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_50'>URL<\/label><div class='ginput_container'><input name='input_50' id='input_10_50' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_10_50'>This field is for validation purposes and should be left unchanged.<\/div><\/div><div id=\"field_10_4\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Program\/Event Information<\/h3><\/div><fieldset id=\"field_10_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I&#039;d like to request:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_28'>\n\t\t\t<div class='gchoice gchoice_10_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Boundaries: Building the Foundation'  id='choice_10_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_0' id='label_10_28_0' class='gform-field-label gform-field-label--type-inline'>Boundaries: Building the Foundation<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Boundaries: Revising the Blueprint'  id='choice_10_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_1' id='label_10_28_1' class='gform-field-label gform-field-label--type-inline'>Boundaries: Revising the Blueprint<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Consent: Sweet as Candy'  id='choice_10_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_2' id='label_10_28_2' class='gform-field-label gform-field-label--type-inline'>Consent: Sweet as Candy<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='De-stress, not distress'  id='choice_10_28_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_3' id='label_10_28_3' class='gform-field-label gform-field-label--type-inline'>De-stress, not distress<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Eating On a Time Crunch'  id='choice_10_28_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_4' id='label_10_28_4' class='gform-field-label gform-field-label--type-inline'>Eating On a Time Crunch<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='How to Help a Friend'  id='choice_10_28_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_5' id='label_10_28_5' class='gform-field-label gform-field-label--type-inline'>How to Help a Friend<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Managing Anxiety'  id='choice_10_28_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_6' id='label_10_28_6' class='gform-field-label gform-field-label--type-inline'>Managing Anxiety<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='SMART Goals and Vision Boards'  id='choice_10_28_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_7' id='label_10_28_7' class='gform-field-label gform-field-label--type-inline'>SMART Goals and Vision Boards<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Short SHAW Overview'  id='choice_10_28_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_8' id='label_10_28_8' class='gform-field-label gform-field-label--type-inline'>Short SHAW Overview<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Sleep on It'  id='choice_10_28_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_9' id='label_10_28_9' class='gform-field-label gform-field-label--type-inline'>Sleep on It<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Swipe Safely'  id='choice_10_28_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_10' id='label_10_28_10' class='gform-field-label gform-field-label--type-inline'>Swipe Safely<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Unhooking from Imposter Syndrome'  id='choice_10_28_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_11' id='label_10_28_11' class='gform-field-label gform-field-label--type-inline'>Unhooking from Imposter Syndrome<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='What is Victim Advocacy?'  id='choice_10_28_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_12' id='label_10_28_12' class='gform-field-label gform-field-label--type-inline'>What is Victim Advocacy?<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='You Can Help! Prevent Sexual and Relationship Violence'  id='choice_10_28_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_13' id='label_10_28_13' class='gform-field-label gform-field-label--type-inline'>You Can Help! Prevent Sexual and Relationship Violence<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='You Can Help! Prevent Suicide'  id='choice_10_28_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_14' id='label_10_28_14' class='gform-field-label gform-field-label--type-inline'>You Can Help! Prevent Suicide<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='You Can Help! Stop Overdose'  id='choice_10_28_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_15' id='label_10_28_15' class='gform-field-label gform-field-label--type-inline'>You Can Help! Stop Overdose<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_28_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='gf_other_choice'  id='choice_10_28_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_28_16' id='label_10_28_16' class='gform-field-label gform-field-label--type-inline'>Other<\/label><br \/><input id='input_10_28_other' class='gchoice_other_control' name='input_28_other' type='text' value='Other' aria-label='Other Choice, please specify'  disabled='disabled' \/>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_10_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_2' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_10_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Program Details<\/h3><\/div><div id=\"field_10_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_32'>What is the course number?<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_10_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_49\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_49'>What is the name of the class?<\/label><div class='ginput_container ginput_container_text'><input name='input_49' id='input_10_49' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_48\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_48'>What School or College does the class belong to?<\/label><div class='ginput_container ginput_container_text'><input name='input_48' id='input_10_48' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_11'>How long is your class meeting time?<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_10_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_13\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_13'>Expected number of students in attendance<\/label><div class='ginput_container ginput_container_number'><input name='input_13' id='input_10_13' type='number' step='any' min='1'  value='' class='large'      aria-invalid=\"false\" aria-describedby=\"gfield_instruction_10_13\" \/><div class='gfield_description instruction ' id='gfield_instruction_10_13'>Please enter a number greater than or equal to <strong>1<\/strong>.<\/div><\/div><\/div><fieldset id=\"field_10_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Location<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_14'>\n\t\t\t<div class='gchoice gchoice_10_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Virtual'  id='choice_10_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_0' id='label_10_14_0' class='gform-field-label gform-field-label--type-inline'>Virtual<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='In person\/On-campus'  id='choice_10_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_1' id='label_10_14_1' class='gform-field-label gform-field-label--type-inline'>In person\/On-campus<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='In person\/Off-campus'  id='choice_10_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_14_2' id='label_10_14_2' class='gform-field-label gform-field-label--type-inline'>In person\/Off-campus<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_44\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_44'>Building name and room number on campus<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_44' id='input_10_44' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_46'>Off-Campus location (include street address)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_10_46' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_18'>Preferred date and time<\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_10_18' type='text' value='' class='large'  aria-describedby=\"gfield_description_10_18\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_10_18'>Please provide at least two weeks notice. We will do our best to accommodate but cannot guarantee to fulfill requests with less than two weeks notice. <\/div><\/div><fieldset id=\"field_10_20\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Is audio\/video available in the room?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_20'>\n\t\t\t<div class='gchoice gchoice_10_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_10_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_20_0' id='label_10_20_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_10_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_20_1' id='label_10_20_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_10_33'>Please share anything you think would be helpful for us to know about your class.<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_10_33' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' 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