Workshop Request

Please complete this form to help us better serve you and your students. This information will be forwarded to the Program Chair of the Counseling Center. Please provide us with at least 2 weeks advance notice for a workshop request. Thank you for working with us to serve our students! Please click here for a list of already scheduled campus workshops provided by faculty counselors through the Academic Success Center.

First Name:

Last Name:

Department:

Phone Number:

Your Email:

Brief description of workshop or program requested

Reason for request/Perceived benefit for participants

Describe what you want the participants to get out of the workshop

Preferred dates and times (If you have no preference, write N/A)

  Date Time
Option 1
Option 2
Option 3

Time allotted for workshop or program

Number of participants expected

Please provide a brief description of the participants (A particular class, student leaders, Staff, Faculty, student organizations, etc.)

Location where workshop or program will be held (Example: B242)