• Requests for outreach programming should be made no less than 2 weeks prior to the date of the proposed outreach program. *
• It is the responsibility of the requesting person/s or organization/s to secure an appropriate location for the proposed outreach program. The location should take into account noise levels and space needs and should be equipped with necessary technology (generally a screen, projector, and laptop, though technology needs may vary by presenter/topic). Any cost associated with the program (technology, location, etc.) is the responsibility of the requesting person/s or organization/s.
• It is the responsibility of the requesting person/s or organization/s to advertise and promote the program once it has been approved so as to ensure adequate attendance. It is furthermore the responsibility of the requesting person/s or organization/s to remain in the room and support the presenter throughout the program. This may include providing access to the room or building at least 10 minutes prior to the scheduled start time, greeting students, assisting with set-up, passing out evaluations, etc.
• Outreach programs are generally 1 hour in length and are delivered by a skilled presenter knowledgeable in the subject requested. Please expect that the presenter will be actively engaged with the audience for a full hour. *
• The University Counseling Center is unable to send counselors to programs/events not presented by or co-sponsored by the University Counseling Center for the sole purpose of assisting in the case a person should be affected by program/event material. Persons/s or organization/s hosting said events may either refer students to the University Counseling Center during regular business hours or contact the University Counseling Center on behalf of a student in need. On-call services are available in the case of an after-hours emergency. More information about crisis/emergency availability can be found at Emergency Services. *
• The University Counseling Center reserves the right to decline participation in a program/event if it has not contributed to its planning and/or does not align itself with its content. Requests for program/event collaboration are welcome and may be made directly through the Outreach Coordinator. *

* The items above are general guidelines of the University Counseling Center. If you would like to request for an exception to be considered, please contact the Outreach Coordinator, Melissa Selby-Theut, at (616) 331-3266 or at [email protected].

Have you read and agree to the above listed guidelines? *
Yes, I have read and agree to the listed guidelines

First Name *

Last Name *

Email *

Phone *

Topic *
- Select Option A Good Nights Sleep Alcohol & Substance Use Body Image Depression, Suicide, Anxiety, and SAD Eating Disorders Friendship Building Healthy Relationships How to Talk so Your Professor Will Listen Making Connections Male Sexual Assault Mastering Your Memory Online Relationships Overcoming Test Anxiety QPR Relationship Screening Self-Injury Sexual Assault Stress Management Surviving a Relationship Breakup Time Management Transitioning Home for the Holidays Transitioning from College to the Work World/Graduate School Transitioning Home for the Summer

Month *
- Select Option January February March April May June July August September October November December

Is this event for a club/group or organization? *
- Select Option Yes No

Club/Group or Organization: *

Specific Date Needed: *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2023 2024 2025 2026 2027 2028

Specific Time Needed: *
- 1 2 3 4 5 6 7 8 9 10 11 12 Specific Time Needed: Minute - 00 30 Is Specific Time Needed: AM or PM - AM PM

Do you have an alternative date? *
- Select Option Yes No

Please list an alternative date: *
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2023 2024 2025 2026 2027 2028

Please list an alternative time: *
- 1 2 3 4 5 6 7 8 9 10 11 12 Please list an alternative time: Minute - 00 30 Is Please list an alternative time: AM or PM - AM PM

Outreach Delivery Preference: *
- Select Option Virtual In-person (Note: In-person events will be subject to UCC availability and will follow recommended safety guidelines. Social distancing and capacity limits may be required.)

Special Requests or Further Instructions: