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
Advisor of Organization, if applicable
Phone Number (include area code)
Email Address
Type of Outreach Programming Please select... Accessing BUCC Services QPR Building Health Relationships Thriving Just Not Surviving Helping Students in Distress Mindfully Managing Stress Around the Table Mental Health First Aid Other
Other Type of Outreach Programming
Name of Event
Preferred Event Date
Preferred Event Time
Alternate Event Date
Alternate Event Time
Event Length
Event Location
Will A/V setup (computer and projector) be available to show slides Please select... Yes No Possible to look into arrangements
Event Format Please select... In Person Virtual (Zoom) when available Open to either option
Target Audience
Anticipated Number of Attendees
How will you be tracking/ensuring attendees
What other departments or organizations could you invite to join or partner with
Request for a Specific Staff Member
Additional Notes
