COUNSELING SERVICES PRESENTATION REQUEST FORM
Please fill out the form and submit; you will be contacted once we receive your request.
Today's Date: (ex: xx/xx/xxxx)
Presentation Topic Wanted: Expected Date for the presentation: (ex: xx/xx/xxxx) Name of class/group to whom this will be presented: Number expected to attend (we request at least 10 participants) Requested length of presentation:
Where the presentation will be held:
Name of Person making the request:
Your title/responsibility:
Office Phone:
Email address: Briefly describe the purpose of the presentation:
Other pertinent information:
Contact phone us at 785-532-6927 or email us if questions.