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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Email *
First and last name *
Affiliation *
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) name of student organization, 2) name of faculty/staff advisor, and 3) email address of faculty/staff advisor. (Answer N/A if you are not requesting on behalf of a student organization) *
What type of outreach are you looking for? *
Please specify any specific topics that you would like covered: *
Reason or background information for request:
Name of event (if applicable):
Preferred Date and Time *
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Alternate Date and time *
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Time allotted for program? *
Will this outreach occur more than once (i.e., for two separate class sections)? *
If yes, what is your preferred date and time for this to occur?
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Location of outreach: *
If in person, what building/room will the outreach take place in:
Please provide a brief description of the audience (e.g., a particular class, student leaders, RAs, Staff, Faculty, student organizations, etc.): *
Anticipated number of participants: *
Additional information to help facilitate your request:
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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