School Activity Request Form
Middle and High Schools ONLY
County (listed is Southern KY AHEC's Service Region)
Number of StudentsAttendees
What type of event
Booth at Health Career Fair
Mega Inflatable Human Body (200 students minimum required) - Take a walk inside the human body to experience the inner workings of various organs (must be inside a gym with a space larger than 50' long x 30' wide x 12 ' high space) Activities must be related to Health Careers.
What health career program are you interested in? (All programs are for in-class 35 students max)
Augmented Interactive Anatomy - Must have Wifi!
Pharmacy Careers - demonstration
Concussion - Fatal Vision Simulation Goggles
Tobacco awareness (vaping)
Behavioral Health Careers DW Eyes Goggles
Optometry Careers - with simulation vision glasses
Respiratory Therapy Careers- Simulation Intubation
How long is your class period?
Potential dates you are looking at (please list at least two)
For Federal Reporting
How many Caucasian Student in the class/group
How many African American Students
How many Asian Students
How many Hispanic Students
Race is not reported
Should be Empty: