CSULB Home Student Affairs Counseling and Psychological Services Outreach Request Outreach Request Requestor Name Pronouns If you are a Student, Staff, or Faculty of CSULB, please provide your Campus ID number Requestor Position Student Staff/Faculty/Administrator Community Member CAPS Staff Class, Organization, or Department Affiliation Email Address, If you are student, staff, or faculty for CSULB, please use your school email. (@csulb.edu or @student.csulb.edu) Telephone Number Outreach Type or Workshop Topic Live Presentation: CAPS 101 (Services & Resources Information) Workshop Virtual/In-person tabling Virtual/In-person Panelist Consultation for Program Development Other: (If other, please specify) Enter other… Please provide a brief description of requested workshop Intended Audience Student Staff/Faculty Parents & Family Expected Number of Participants What do you hope your audience will take away from this outreach? (e.g learning goal, outcomes, etc.) Do you require disability related accommodations? (e.g. live captioning, interpreter, etc.) Disability related accommodations are arranged through the Bob Murphy Access Center (BMAC). Accommodations require minimum 72 hours advance notification and availability of BMAC services may be limited Any additional comments regarding outreach program information Preferred Date(s): (If multiple dates/times are being requested, please specify) Preferred Time(s) If virtual, please specify your preferred virtual conferencing platform Zoom Microsoft Teams If virtual, do you need a recording of the workshop or program? Yes, I need a recording No, I do not need a recording Will anyone be available to help manage and monitor the workshop? We recommend having a person designated to help the workshop facilitator with passing out material, monitoring the waiting room, participant list, and/or chat box Yes, help will be available to manage the virtual workshop. No, I do not have anyone to help manage the virtual workshop. Any additional comments regarding virtual program logistics?
