Outreach Request Form

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Thank you for your interest in our outreach programs. Please fill this quick survey regarding your outreach request.

Once your request has been submitted, please allow up to 5 business days to receive a response.

Note: We attempt to fulfill all outreach requests that fit our mission and our availability. Requests made less than 2 weeks prior to the event or during our highest demands for direct counseling services during the semester may not be able be fulfilled.

Today's Date *

YYYY

Name and Last Name *

Email Address *

Department/Organization *

Preferred delivery for the outreach *

In person

Zoom

Location (if not virtual)

Topic for the presentation *

Counseling Center Services

You Can Help A Friend (60-minute training for Students)

You Can Help a Student (90-minute training for Faculty and Staff)

Managing Anxiety

Managing Depression

Healthy Relationships

Emotion Regulation

Loss and Grief

General Overview of Mental Health

Preparing for Midterms/Finals

Perfectionism

Interpersonal Violence and Consent

Self- Care for Campus Leaders

Healthy Boundaries

Resource/Info Table

Other:

Required

Please provide a brief description of your event. *

Length of Outreach *

10-20 minutes

30 minutes

45 minutes

1 hour

Other:

Estimated # of attendees *

Who will be attending? (Select all that apply) *

Undergraduate Students

Graduate Students

Faculty

Staff

Other:

Required

Options of dates/times for outreach *

Will the presenter have access to the necessary technology to show a presentation?

Yes

Clear selection

Other comments

Submit

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