Contact Information

Name of Organization

Name of Person Making Request



Event Information

Event Description: Please provide details of the event and what you would like us to do. Please be as specific as you can as this helps us with our preparation.

Date of Outreach Activity Requested*

Start Time of Outreach Activity

End Time of Outreach Activity

Event Venue and Address

Number of expected participants:

Type of outreach activity:

Will you have A/V equipment available (projector, computer, speakers, etc.) if needed?


*We will try to accommodate every request. Due to time constraints, clinical demands and staff availability, it is possible that a request may not be able to be filled. Please allow 3 weeks' notice to ensure the best possibility for a request to be accommodated.

For more information, please contact Alanna Carrasco at the Student Counseling Center.