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 ______ 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.

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

Hall or Organization:

Contact Person:

Contact E-Mail:

Contact Phone:

Staff Advisor:

Phone #:

Topic Requested:

Location of Workshop:


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

<July 2008>
SunMonTueWedThuFriSat
293012345
6789101112
13141516171819
20212223242526
272829303112
3456789
1st Choice: [Please Select a Date] (time)
<July 2008>
SunMonTueWedThuFriSat
293012345
6789101112
13141516171819
20212223242526
272829303112
3456789
2nd Choice: [Please Select a Date] (time)
<July 2008>
SunMonTueWedThuFriSat
293012345
6789101112
13141516171819
20212223242526
272829303112
3456789
3rd Choice: [Please Select a Date] (time)

Approximate Duration:

# of People Expected:

Purpose of Workshop - e.g. (Requirement, Educational purpose(s), Interest, Conflict within the Residence Hall)

What Areas Do You Specifically Want Addressed?

If you are a student, please have your staff or faculty advisor/supervisor review and sign below.

__________________________________________
Staff/Faculty Member