CWC Presentation and Outreach Request Form

If you are interested in requesting a classroom or an outreach presentation from the Counseling and Wellness Center, please complete the Presentation and Outreach Request Form below.

If you are hosting an event, you can also request a counselor to be present. Providing counselor support is beneficial for events that may be triggering for some attendees, and having a counselor present will give students an opportunity to process feelings that have come up for them while attending the event.

• • Please provide us with 3 weeks’ notice and ensure that there will be a minimum of 10 participants in attendance.


• • We will try to accommodate the preferred date requested; however, based on availability this may not be possible. Please provide several alternative dates and times.


• • We will review your request and respond within a week.

First name*
Last name*
Phone*
Email*
Date you would like presentation*	[None]
Time of presentation (start and end time)*
Alternative presentation date*
Time of event (start and end time)*
Presentation/event location*
Presentation/event location type*	(Select) In-person Virtual Hybrid
Name of organization/class/department*
Anticipated number of people who will attend*
Length of presentation*
Type of program or topic you are requesting*
Are there any specific things you want to be addressed on the selected topic?*
Additional information
Request for counselor support at events*	No Yes