Peer Program Presentation Request Form: The Blues Project Fall 2019
The Blues Project is a peer education program through University Counseling Services that conducts psycho-educational presentations in the area of depression education and suicide prevention. Topics in these presentations include understanding myths and stigmatizing language around suicide, methods to support students in distress, and community resources or programs that may assist students in these areas. To request a presentation, please complete the brief questionnaire in the link below.

You will receive an email within a week of your request as confirmation.

For questions, please email Steven Wang (Peer Education Coordinator) at Steven.Wang@csun.edu
Sign in to Google to save your progress. Learn more
First/Last Name of Peer Educator Generating Presentation (For Professors: Please mark: "N/A") *
Person A (For Professors: Please mark: N/A) *
Person B (For Professors: Please mark: N/A) *
Date of Presentation (Please schedule presentation date at least 7 days from today) *
MM
/
DD
/
YYYY
Time of Presentation (e.g. 8:30 AM) *
Time
:
Length of Presentation (e.g. 30 minutes - 1 hour) *
Professor's Name *
Professor's Email Address (e.g. Matty.dor@csun.edu) *
Course Number (e.g. Psych 321, Soc 1, etc.) *
Room Location (e.g. SH 213) *
Class Size (e.g. 30 students) *
What technology is available? (e.g. Smart Room, Black Box access, etc.) *
Additional Comments/Feedback? (If none, please mark: N/A) *
Thank you for scheduling a presentation with the Blues Project program! Within 72 hrs of submitting your request, we will send you a confirmation email of your scheduled presentation with your request details.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms