Mental Health Outreach Request

Mental Health Outreach Request

Program/Event Information

The Marquette University Counseling Center is dedicated to serving the MU community and supporting efforts to advocate for mental health. Meeting students in the spaces where they learn, work, and live can normalize counseling and connect students to resources. Please utilize the following form for requests for counseling center staff to support, lead, attend or facilitate outreach opportunities. Common outreach requests include leading mental health discussions or presentations or facilitating training about mental health-related topics (suicide prevention, mindfulness, self-care/wellness, etc.).

In order to best accommodate requests, please submit inquiries at least 2-3 weeks in advance. If you do not receive a response in 2-3 business days, please contact the counseling center at (414)-288-7172 and ask to speak with the Outreach Coordinator.

First and Last Name *

Status *Undergraduate student, graduate student, faculty, or staff

Department/ Program (if applicable):*

Event/Program Topic:*What is the purpose of the outreach event?

Intended Goals or Outcomes of the Program/Event:*What do you hope to accomplish with this outreach activity? What can the Counseling Center provide? (Examples: education/information, discussion/consultation, clinical support during/after an event, etc.)

Audience:*Who will be attending the event/activity?

Expected number of student attendees: *

Expected number of other attendees: *

Length of Program/ Event: *How long is scheduled for the outreach activity?

Location:*Where will the outreach activity take place?

Preferred Date and Time:*Please include up to 3 available times/dates.

Event/Program Format:*What format are you hoping for? (Presentation, facilitated conversation, etc.) What resources are available or needed? (AV setup, white board, etc.)

Additional information: What additional information do you want us to consider as we process your request?

Event/Program Contact (if different than requesting contact)

Phone number

email: