Outreach Request FormPlease complete this form for any program requests at least two weeks in advance. You will hear back from us within 3 business days.You must have JavaScript enabled to use this form.Indicates required field Contact InformationNamePhone NumberEmailOrganization (if applicable)CU Affiliation Student Faculty Staff Student group Residence Hall Campus department UnaffiliatedSelect all that applyProgram InformationTopic Requested Alcohol and other drugs and recovery Grief and loss Health equity Information about Health and Wellness Services Mental health Nutrition Relationship wellness Sexual health Sleep Stress and anxiety Supporting Survivors: How to Respond to Disclosures of Trauma Suicide prevention Impact of trauma and the healing process Trauma-informed mandatory reporting for responsible employees OtherWhich department would you like to learn more about? CU Collegiate Recovery Center Counseling and Psychiatric Services Health Promotion Office of Victim Assistance Recreation Services Wardenburg Health ServicesIf other, please describeLearning OutcomesDescribe what you hope your participants will gain from attending this program. Please be specific.Intended Audience CU students CU faculty and/or staff OtherIf other, please describeType of Presentation Interactive Informational talk Panel TablingPlease indicate what type of presentation you would likeIs this request in response to a specific incident? Yes NoWould you like a consultation prior to scheduling a presentation? Yes NoDate OptionsPlease list 2-3 date options, with your preferred date listed first.Time OptionsPlease list 2-3 time options (ex: 6 PM - 7 PM, 3 PM - 4:30 PM, etc.)Estimated Number of AttendeesAre you planning any other activities during the presentation?If so, please describe them here.
