Outreach Request Form
Thank you for your interest in University Health Services' Prevention & Population Health!  As part of our commitment to our Aggie community we offer a variety of mental health and primary care focused initiatives. We look forward to working with you, please complete the form below and a representative will contact you. If this request is due to a crisis or tragedy please contact, Administrative Coordinator, Monica Colson directly at 979-845-4427. If the event requested has multiple dates please include that information, or complete another form for tracking purposes.
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Please allow 3 weeks advance notice for requests. Due to the limited availability of staff or busy times during the semester, some presentation requests may be declined. *
Required
What type of outreach are you requesting? *
Required
What kind of format do you prefer? (If selecting other please specify email or phone communication, etc.) *
Proposed Date and Time *
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Alternate Date and Time *
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What is the allotted amount of time for this request? *
For presentations please request a minimum of 30 minutes and for a workshop a minimum of 45 minutes
Who is this request for? *
Required
Please describe who will be in the audience. Example: First Gen Student, Grad Students, etc. *
Expected # of Attendees (Minimum of 10) *
Please select the primary topic(s) to be covered *
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