Community Class Request Form | Healthcare Literacy Council

Organization name

Organization type

Other

Primary contact name

Email

Phone

Mailing address

Preferred language of community class

English

Spanish

Other

Preferred timing for community class

Within the next month

Within the next 3 months

Within the next 6 months

By May 2026

Preferred day and time of community class (select all that apply)

Weekdays during work hours (8 a.m.–5 p.m.)

Weekdays after work hours (5–8 p.m.)

Weekends during the day (8 a.m.–5 p.m.)

Weekends in the evening (5–8 p.m.)

Brief description of audience and/or event

Additional comments or questions

Request a Community Class