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CAPS Outreach Request
Please complete this form for your CAPS outreach request. Please submit your request at least 21 business days in advance of the event. We may not be able to meet your request if it is submitted on shorter notice or during high impact times.
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* Indicates required question
Email
*
Your email
First and last name
*
Your answer
Affiliation
*
Student
Faculty
Staff
Other:
If you are requesting this outreach on behalf of a student organization, your faculty/staff advisor
must
be involved in the outreach planning process. Please provide the following information:
1)
n
ame of student organization, 2) n
ame of faculty/staff advisor,
and
3) e
mail address of faculty/staff advisor.
(Answer
N/A
if you are not requesting on behalf of a student organization)
*
Your answer
What type of outreach are you looking for?
*
CAPS services presentation
Interactive workshop
Presentation on a specific topic (lecture)
Tabling
Group debriefing
Participation on a panel
Interview
Other:
Please specify any specific topics that you would like covered:
*
Your answer
Reason or background information for request:
Your answer
Name of event (if applicable):
Your answer
Preferred Date and Time
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Alternate Date and time
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Time allotted for program?
*
30 minutes
1 hour
More than 1 hour
Other:
Will this outreach occur more than once (i.e., for two separate class sections)?
*
Yes
No
If yes, what is your preferred date and time for this to occur?
MM
/
DD
/
YYYY
Time
:
AM
PM
Location of outreach:
*
Zoom/virtual
In person
If in person, what building/room will the outreach take place in:
Your answer
Please provide a brief description of the audience (e.g., a particular class, student leaders, RAs, Staff, Faculty, student organizations, etc.):
*
Your answer
Anticipated number of participants:
*
Your answer
Additional information to help facilitate your request:
Your answer
Thank you for filling out this form. Our Assistant Director for Outreach will be in touch soon.
A copy of your responses will be emailed to the address you provided.
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