Counseling and Psychological Services
Workshops, Outreach, and Psychoeducational Programs

Workshop Request Form

  • Please provide the following information. All workshop / program requests must be submitted two weeks prior to the requested workshop / program date.

    All fields are required

    Personal Information




    Phone Number  



    Brief description of workshop or program requested

    Reason for request / Perceived benefit for participants

    Describe what you want the participants to get out of the workshop

    Dates and Times

    Preferred dates and times (If you have no preference, write N/A)

    Option 1 Date  

    Option 1 Time  

    Option 2 Date  

    Option 2 Time  

    Option 3 Date  

    Option 3 Time  

    Time allotted for workshop or program

    Number of participants expected

    Please provide a brief description of the participants (A particular class, student leaders, RAs, Staff, Faculty, student organizations, etc.)

    Location where workshop or program will be held