Get Connected: Submit Your Opportunity

Opportunity Name/Title

Opportunity Name/Title (required)

Contact Information

Contact name (required)
Email (required)
Contact title
Phone
Host Organization Website (please include the full URL, Example: http://www.mywebsite.com)
Name of Individual Filling Out This Form if Different from Above
Email of Individual Filling Out This Form if Different from Above

Description of Opportunity

Brief description
Opportunity Webpage Link (if applicable, provide full URL of your opportunity's webpage, Example: http://www.mywebsite.com/link2event)

Opportunity Offerings

Opportunity Type (select one and enter date(s) in the relative Opportunity Type below)
Note: The "Ongoing" Opportunity Type does not require a date to be entered.

Opportunity Type: Scheduled - Offered on Specific Date(s)
Opportunity start date
Opportunity end date (if applicable - e.g., opportunity offered 3-1-15 thru 3-15-15)

Flyers and Informational Documents (PDF only. Limit 4MB.)

PDF Upload
PDF Upload

Host Organization Name (Select the organization hosting this opportunity)

(If your organization is not listed, please provide the name of your organization)
Add New Organization

Opportunity Location (Choose the community or campus location where the opportunity is taking place. This may be the same or different than the host organization. )

Community Location
Campus Location
(If your opportunity location is not listed, please provide the location of your opportunity)
Address 1
Address 2
City
Zip code
Google map URL

Opportunity Categories (choose all that apply)

Health Categories

Health Topics

Audiences

Other (is there a category we should add that is not listed above?)