Dear Instructors,

Please complete the brief questionnaire below to submit your request for a classroom presentation on the Mental Health Counseling Center & Student Health Clinic on campus. We offer 15-minute presentations or 30-minute PowerPoint presentations. Due to limited staffing, we typically offer presentation times during daytime hours. If you would like an evening presentation, please continue to fill out the request and we will do our best to accommodate your needs. If you are requesting presentations for multiple courses, please complete one form for each course.

You will receive an emailĀ confirming a date and time for your presentation. If you have any questions please contact Abigail Weisman at
Thank you!

* 1. Instructor Name

* 2. Instructor Email Address

* 3. Course Name & Number (e.g. ENGL 101)

* 4. Building & Room Number

* 5. Course Meeting Days (select all that apply)

* 6. Course Meeting Time

* 7. Number of Students Enrolled in Course

* 8. Length of Presentation

* 9. Please note any special instructions below