Outreach Request Form | Counseling and Wellness Center

Required fields are marked with an asterisk (*).

Outreach Request

Thank you for inquiring about an outreach program through the Counseling and Wellness Center. Please answer the following questions in as much detail as possible to help us respond to your request.

We kindly ask that all outreach requests allow for a minimum of two weeks advance notice. If your request is urgent or time sensitive, please let us know and we will do our best to meet your needs. While we will do our best to meet your needs, we may not be able to accommodate every request.

If you have questions or need further support, please contact the Counseling and Wellness Center at 360-650-3164 or cwc@wwu.edu.

First and Last Name

Phone

WWU Email

What part of campus do you represent?

Academic Department Name

Enrollment & Student Services Department Name

Other WWU Department Name

Preferred days/times for the program (please provide at least 3 options).

Which format would you prefer?

In person

Virtual

No preference

How many people do you expect to attend?

What presentation are you requesting?

Suicide Prevention (90 minutes)

Consent and Healthy Relationships (90 minutes)

Stress Resilience (60 minutes)

Mental Wellness Resources at WWU (30 minutes)

Who is the intended audience for this program? (Select all the apply)

Students

Faculty

Staff

Student employees

Other

Are there any specific accommodations needed?