Outreach Request FormPlease complete this form for any program requestsÌýat least two weeks in advance.ÌýYou 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 AffiliationÌý StudentÌý FacultyÌý StaffÌý Student groupÌý Residence HallÌý Campus departmentÌý UnaffiliatedSelect all that applyProgram InformationTopic RequestedÌý Alcohol and other drugs and recoveryÌý Grief and lossÌý Health equityÌý Information about Health and Wellness ServicesÌý Mental healthÌý NutritionÌý Relationship wellnessÌý Sexual healthÌý SleepÌý Stress and anxietyÌý Supporting Survivors: How to Respond to Disclosures of TraumaÌý Suicide preventionÌý Impact of trauma and the healing processÌý Trauma-informed mandatory reporting for responsible employeesÌý OtherWhich department would you like to learn more about?Ìý CU Collegiate Recovery CenterÌý Counseling and Psychiatric ServicesÌý Health PromotionÌý Office of Victim AssistanceÌý Recreation ServicesÌý Wardenburg Health ServicesIf other, please describeLearning OutcomesDescribe what you hope your participants will gain from attending this program. Please be specific.Intended AudienceÌý CU studentsÌý CU faculty and/or staffÌý OtherIf other, please describeType of PresentationÌýInteractiveÌýInformational talkÌýPanelÌýTablingPlease indicate what type of presentation you would likeIs this request in response to a specific incident?ÌýYesÌý NoWould you like a consultation prior to scheduling a presentation?Ìý YesÌý 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.
