OCS Outreach Request Form

OCS Outreach Request Form

Thank you for your interest in partnering with the Office of Counseling Services. Please complete the request form below. We kindly ask that all requests be submitted at least three weeks in advance to allow adequate time to identify facilitators and tailor the program to your specific goals.

While we make every effort to accommodate requests, please note that during peak times of the year or outside of regular business hours, our availability may be limited. In such cases, we are happy to recommend alternative resources or explore opportunities to collaborate at a different time.

Name Name * First Last
ODU E-mail *
Contact Phone Number Contact Phone Number - ### - ### ####
ODU Affiliation *

ODU Affiliation Student Staff Faculty Other Other
Organization/Department *
Program Details

Please note: This is not a request for therapy services. If you would like to schedule an individual appointment, please call 757-683-4401 and dial option 1.
Type of Program Request *

Type of Program Request Mental Health Presentation Resource Tabling Event Overview of Counseling Services Panel Participation Interview Other Other
Program Topic / Name of Event *
Estimated Number of Attendees *
Preferred Date of Event Preferred Date of Event * / MM / DD YYYY
Start Time of Event Start Time of Event * : HH MM AM/PM
End Time of Event End Time of Event * : HH MM AM/PM
Alternative Date (Option 2) Alternative Date (Option 2) / MM / DD YYYY
If you would like to provide more information about the date, time, or duration of the program, please do so here
Event Location (Building/Room#) *
Preference *

Preference In-Person Virtual No preference
Goals for the Requested Program/Related Audience Needs *
Any Additional Comments/Relevant Details: