Outreach Request Form Please submit this form at least three weeks in advance of the program you are requesting. This form is not used for scheduling counseling appointments. Name Phone Email Class/Organization What topic are you requesting for your presentation? Introduction to Counseling Services Stress management Suicide prevention Relaxation/Meditation/Mindfulness skills Getting better sleep Test anxiety Perfectionism Procrastination Eating disorders and body image concerns How to help a friend Motivation Examining your relationship with alcohol and other substances Is it depression or just the blues? Transitioning to college-level academics Healthy relationships Building assertiveness skills Get in the zone Other (please describe below) If other, please describe presentation topic: Proposed date Alternative date Proposed start time Proposed end time Alternative time Number of participants expected Location Computer and projector available? Yes, both are available No, neither are available Projector is available, but no computer Additional information reCAPTCHA Email Submit Δ
