Outreach & Prevention Program Request Form

The Counseling Center offers a variety outreach programs and presentations to the Towson community. Please choose a topic from the outreach menu below.

Due to the high volume of program requests and clinical demand, we ask that you submit a request form 3 weeks in advance of your preferred date. If you have questions, please contact the Counseling Center by calling 410-704-2512, Monday through Friday, 8 am to 5 pm. 

An asterisk (*) denotes required fields. 

Section

1. Name of person requesting program: 

2. E-Mail of person requesting program (Please enter TU email):

3. Phone Number of person requesting program:

4. Department or Organization requesting program:

5. What is your position in the department or organization?

Please select... Faculty/Staff RA/Housing Staff Student Student Org Leader Student Org Advisor

6. Who is the intended audience?

Please select... Students Faculty and staff General TU community (students, faculty, staff)

7. Choose 1 program topic that best fits your purpose

Please select... Adjustment to College Life: Self-Care for Undergraduate Students Anxiety + Depression 101: Signs, Symptoms, and Support Conversations About Conversations: Increasing Skills for Assertive Communication and Conflict Resolution Developing Self-Compassion: A Skill to Build General Counseling Center Information Mindfulness: Myth Busting and Practice Tabling At Your Event Too Stressed to De-Stress: Stress Management Self-Reflection and Practice

8. Please estimate the duration of your program:

Please select... 20-30 minutes 30-45 minutes 45 minutes – 1 hr 1 hour – 1.5 hours 1.5 – 2 hours 2+ hours

9. 1st Preferred Date (please choose date 3 weeks in advance of request):

2nd Preferred Date:

3rd Preferred Date:

10. Preferred Time: (Specify AM or PM, i.e. 8 AM. Do Not enter time range.)

11. Place/Location:

12. Number of attendees expected (we ask for a minimum of 10 audience participants):

13. Is there presentation equipment at the location of the event (i.e., computer, projector, etc.)?

YesNo

14. Is there microphone and speaker access as some presentations have a video component?

YesNo

15. Is the presenter able to arrive early to set up?

YesNo

16. Additional comments/information regarding your request (describe your audience):

 

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