GSU Counseling Center - Outreach Event Request Form
The Counseling Center offers a variety of educational programs for students, campus clubs/organizations, faculty, and staff.

Examples of program topics typically requested include: information about Counseling Center services, stress management and relaxation training, depression, assertiveness, adjustment to college, career decision making, communication skills, sexual assault/date rape, gay/lesbian/bisexual/transgender issues, crisis debriefing, and eating disorders/body image.

For ideas about additional programs our staff can provide for you, take a look at our Self-Help Topics.

All outreach requests must be submitted using the below Outreach Program Request Form. In making your request, please keep the following in mind:

1) Make your request at least two weeks in advance of your desired program date. As the semester progresses and gets busier, we may need more advanced notice.

2) You must have at least 8 audience members attend your program.

3) If you are an instructor, please limit your request to one per class each semester. Instructors and/or other faculty members are required to be present at requested outreach programs.

4) We can more easily fill requests for programs that are scheduled during regular business hours (9:00-5:00).

Please be aware that it is possible that we will be unable to fill your request due to time constraints or availability. However, we can often assist you with information or handouts.

Please fill in all of the following information before submitting this form. Your request will be processed by our Outreach Coordinator within just a few days. Thank you for contacting the Georgia Southern University Counseling and Career Development Center!

Name
Your answer
Department/Position in Organization
Your answer
Phone/Contact Number
Your answer
E-Mail Address
Your answer
Desired Date for Outreach Program
MM
/
DD
/
YYYY
Day of the Week
Desired Start Time for Outreach Program
Time
:
Desired End Time for Outreach Program
Time
:
Location (Building, Room Number, Address, etc.)
Your answer
Presentation Topic
Your answer
Expected Number of Attendees/Participants
Your answer
Brief Description of Your Audience
Your answer
Other Comments/Information
Your answer
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