Interested in bringing the Explorer to your community?

Submission Date/Time
Month - Day - Year
Hour : Minutes
OUHSC Username
First Name
Last Name
Mobile Phone
Area CodePhone Number
Email
Your Title
Name of your organization
Title of event or initiative
Brief description of event
How many participants are you expecting to attend the event?
What is the expected approximate age range of the participants?

1 - 10 yr
10 -18 yr
18 - 65 yr
65+ yr
Date Desired
Month - Day - Year
Event Time Start
Hour : Minutes
Event Time End
Hour : Minutes
Street
City
State
Zip
Please click here to review and learn more about all the services the Explorer offers before requesting our services.
What services would you like OUHS students and/or faculty to provide at this event?

Educational Outreach Services
Health Outreach Services
Other (specify in Additional Comments section)
Additional Comments
Please note that we reserve the right to cancel or reschedule any upcoming event if we have concerns regarding the safety of our participants, staff, or attendees. In such cases, we will make every effort to provide notice at least 24 hours in advance of the scheduled event. Thank you for your understanding.

Month	-	Day	-	Year
Hour	:	Minutes