Outreach Request Form

Event Title

Event Host (organization/department/school)

Event Format/Location (Zoom, Teams, Library Mall, Dejope, etc. Include room number)

Please select an outreach topic:

Meditation
Stress management
Sleep Hygiene
Accessing MHS services and overview of services
Optional scenario practice or discussion follow-up to online Suicide Prevention Training for Faculty and Staff or Students
Panel discussion (Share more information about the panel in the last text box.)
Tabling event (Share more information about the event in the last text box.)

Date of event

Backup date (if applicable)

Event Start Time

:

Event End Time

:

Audience (select all that apply):

Estimated number of event attendees

Please arrange to have a sign-up sheet if available. Events must have at least eight attendees in order to have an MHS staff member present.

Contact Person

Contact Office Phone

Contact Cell Number

Contact Email

Is there anything else we should know about the event?