Counseling and Student Accessibility Services Outreach Presentation Request Form

Counseling and Student Accessibility Services provides outreach, presentations, and workshops on a variety of topics promoting student success and holistic well-being.


Please complete the Outreach Request Form to request any of our programs or individual interview. We will make every effort to fulfill your request but there may be times when our availability is limited during peak demand for services; especially during mid-terms and finals. To best accommodate availability, please allow 4-weeks notice when requesting a program or training. Outreach programs may be in person or offered virtually via WebEx upon request. You will need to choose your preference on the form.


Please note that we make an exception to the 4-weeks advance notice policy as needed, and if you have not been contacted within 7 business days of your submission, please call us at (229) 500-2013 or email counselingservices@asurams.edu.

Event Organizer Information


Phone

Event Information


Event Duration*
Event Format*
Who Are You Requesting for Program?

Presentation Type


Type of Outreach*

Additional Information (Optional)


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