Emergency Services | How to Make an Appointment | Maps & Directions | Site Map

Requesting Outreach Services

Introduction

Students requesting outreach services must first have the approval of a faculty / staff member who has reviewed the request.  Due to the many responsibilities of Center staff and the large request for services, we must require a minimum of ten audience members at each function.  Requests received at least three weeks in advance with at least three prioritized “choice dates” have a greater likelihood of being accommodated. If you would like to access any of the outreach services provided by the Counseling Center, please complete the Request for Counseling Center Outreach Service(s) Form below. Please contact Ken Caillet, Ph.D. at (949) 824-6457 should you require consultation regarding your request.

We also encourage you to familiarize yourself with the Friends Helping Friends Presentations offered every Spring Quarter by members of the Counseling Center’s Peer Educator Program.


Requesting Outreach Service(s) Form

Request for Counseling Center Outreach Service(s) Form

Organization Information (please fill in all fields)
Organization Name
Contact Person
Contact Email
Contact Phone
Location of Event
Staff/Faculty Advisor
Advisor Phone

Audience Members: (select one)





Service Requested: (select one type of outreach service - i.e. Workshop/Training, type of Presentation, or type of General Outreach)



Presentation







General Outreach





Topic Requested: (select one)





























Date and Time (please include range of dates and times possible) 

<November 2009>
SuMoTuWeThFrSa
25262728293031
1234567
891011121314
15161718192021
22232425262728
293012345
1st Choice: [Please Select a Date] (time) e.g. 9:00 AM
<November 2009>
SuMoTuWeThFrSa
25262728293031
1234567
891011121314
15161718192021
22232425262728
293012345
2nd Choice: [Please Select a Date] (time) e.g. 9:00 AM
<November 2009>
SuMoTuWeThFrSa
25262728293031
1234567
891011121314
15161718192021
22232425262728
293012345
3rd Choice: [Please Select a Date] (time) e.g. 9:00 AM
Approximate Duration:
# of People Expected:

Reason for request - e.g. (Requirement, Educational purpose(s), Interest, Help resolving an identified problem)
 
What Areas Do You Specifically Want Addressed?