Request an Outreach Program

Please complete the form below to request an Outreach Program. If you have any questions or difficulties completing this form, please contact the Counseling Center at 410-516-8278. Please note that we require at least 2-3 advance notice in order to provide the best service.

Request an Outreach Program

Today's Date*

Your Name*

Phone Number*

Email Address*

Department*

Program Topic*

Please choose from one of the below options.

Counseling Center Services (general information about the services and how to connect to the Counseling Center)Stress Management (information about stress, ways to cope with stress)Mindfulness & Meditation (information and techniques)How to Assist Students in Mental Health DistressOther (please describe)Program Topic

Requested Program Date*

Please note that we typically need at least 2-3 weeks advance notice for a requested program or presentation.

Alternate Date*

Goals for the Requested Program/Related Audience Needs*

Access to Technology*

Computer

Projector

Technical Assistance in Person

Please check all that apply.

Length of Program Requested*

Number of Participants Expected*

Additional Comments