Last Name:
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First Name:
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Email Address:
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Phone:
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Your Role:
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Faculty
Staff
Undergraduate Student
Graduate Student
Other
Department or Group Affiliation:
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General topic requested for session:
Alcohol and Other Drugs
Mental Health
Sexual Health
Create Your Own (required minimum of three weeks' notice)
Choose the type of session you're looking for:
Micro-engagement: quick drop-in for information and resources, located in high-traffic area, with an optional activity
Workshop: set time involving active engagement of participants
Choose an option for an Alcohol and Drugs Micro-engagement:
Weeding Out the Myths and Mis-perceptions Trivia (Cannabis)
Medical Amnesty Trivia
Standard Drink Pouring (Alcohol)
Building Safer Habits: Alcohol and Other Drugs Trivia with Giant Jenga
Choose an option for an Alcohol and Other Drugs Workshop:
Alcohol & Cannabis 101
TLDR: Alcohol safety and medical amnesty
DIY Drink Counter Bracelets
Choose an option for a Mental Health Micro-engagement:
Green Bandana Project: dedicated to preventing suicide through promotion of help-seeking and increasing mental resource awareness
Choose an option for a Mental Health Workshop:
Suicide Prevention Training: Question, Persuade and Respond (QPR)
Imposter Phenomenon: How to combat those feelings that you’re not good enough
Sleep Tips and Tricks: to improve sleep quality
Meditation/Mindfulness
Stress Management/Self Care
Assisting Students in Distress
Choose an option for a Sexual Health Micro-engagement:
STI Risk Reduction and Contraception
Choose an option for a Sexual Health Workshop:
Sexual Health Trivia (30-minute or 1-hour session only)
Sex in the Dark: interactive sexual health education program where questions can be submitted anonymously and answered by a facilitator (90 minute session only)
Tell Us What You're Looking For:
Date-First Choice:
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Month
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Day
Year
Date
Time-First Choice:
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Hour Minutes
AM
PM
AM/PM Option
Date-Second Choice:
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Month
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Day
Year
Date
Time-Second Choice:
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Hour Minutes
AM
PM
AM/PM Option
Date-Third Choice
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Month
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Day
Year
Date
Time-Third Choice
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Hour Minutes
AM
PM
AM/PM Option
Length of Outreach Program Desired:
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30 minutes
45 minutes
1 hour
Other
Location:
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Intended Audience:
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Faculty
Staff
Undergraduate Students
Graduate Students
Other
Estimated size of Audience:
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Technology Available:
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Internet Connection
Computer
Video Display
Audio System or Amplification
Is this part of a larger event?
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Yes
No
Briefly describe the event and how this fits In:
Is there anything else you would like us to know about your request?
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