Outreach Request Form

To request a workshop/training, please fill out and submit this form to the counseling and psychological services. Workshop/trainings must be submitted at least two weeks in advance of your desired date. Once you have submitted this form, you will be contacted by someone from our office.

INFORMATION

Name

Phone Number

WORKSHOP/TRAINING REQUEST

Workshop/Training

Yes No

Introduction to CAPS and Services

Yes No

Reception/Table at Fair

Yes No

Which Reception or Fair?

Other

Please describe what type of workshop/training you are seeking that is not listed.

BRIEF DESCRIPTION OF WORKSHOP/TRAINING REQUEST

Suggested Title

Preferred Date and Time

Month

Day

Year

Hour

Minute

AM/PM

Length of Presentation

(30 minutes, 1 hour, etc)

Location for Workshop/Training

Expected Attendance