Step 1Complete the Request Form
Step 2Confirm Request Information
Step 3Finished
Please submit your request 2 weeks in advance of the event. While every effort will be made to fulfill outreach requests, The Baylor Counseling Center cannot ensure that every request can be accommodated.
First Name
Last Name
Organization
Position
Phone Number(include area code)
Email Address
Type of Outreach Programming Please select... General Information Stress Management/Anxiety Depression/Suicide Sleep Deprivation Other
Other Type of Outreach Programming
Name of Event
Preferred Event Date and Time
Alternate Event Date and Time
Event Length
Event Location
Target Audience
Number of Attendees
Additional Notes