GW Well-being Outreach Form

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Thank you for your interest in submitting an outreach request. Please note that this form is used to request outreach services from Medical Services, Counseling & Psychological Services (CAPS), Health Promotion & Education, and Lerner Health and Wellness Center in order to better serve students. If you are looking for information about faculty/staff well-being, please go to hr.gwu.edu/your-life-gw.

So that we can best meet your needs, please fill out this form in its entirety. If the form is not filled out completely, your request may be denied, and you may be asked to fill it out again.

Once you have submitted a request, a staff member from one of the previously mentioned offices will follow up with you.

Please complete 1 form per outreach request.

If you have any questions, email wellbeing@gwu.edu.

Email *

First and last name of contact person *

Contact person's organization, group, department, or residence hall *

Phone number of contact person *

Type of outreach requested *

I am requesting an information/contact table

I am requesting a formal presentation, workshop,

I am requesting an informal Q & A or meeting to discuss servcies

I am requesting a Responsive Support Space (ex. community support/dialogue)

I would like to collaborate with an office for an event hosted by my organization, group, or department

I am requesting sexual health barriers for my club, organization, or residence hall

I am requesting a different kind of outreach.

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