Outreach Request In order to best accommodate requests, please submit inquiries at least 2-3 weeks in advance. Program/Event InformationEvent/Program Topic* What is the purpose of the outreach event?Intended Goals or Outcomes of the Program/Event:* What do you hope to accomplish with this outreach activity? What can University Counseling Services/Health Promotion and Wellness provide? (Examples: education/information, discussion/consultation, clinical support during/after an event, etc)Audience:* Who will be attending the event/activity?Expected number of students attendees:* Expected number of other attendees: Length of Program/Event How long is scheduled for the outreach actvitiy?Location Where will the outreach activity take place?Preferred Date and Time* Please include up to 3 available times/dates.Event/Program Format:*What format are you hoping for? (presentation, facilitated conversation, etc) What resources are available or needed? (AV setup, white board, etc)Additional Information:What additional information do you want us to consider as we process your request?Event/Program ContactName* Email:* Phone Number: