UCI students, staff, and faculty requesting outreach services must complete an Outreach Request Form (below). If you are a student requesting a presentation for your student group or organization you must have the permission from your faculty/staff advisor first. Due to the many responsibilities of Center staff and the large request for services, we must require a minimum of 10 audience members at each function. Requests received at least three weeks in advance with at least three prioritized “choice dates” have a greater likelihood of being accommodated. If you would like to access any of the outreach services provided by the Counseling Center, please complete the Outreach Request Form below. We also encourage you to familiarize yourself with the Friends Helping Friends Presentations offered every Spring Quarter by members of the Counseling Center’s Peer Educator Program.

Please wait a few moments to receive a confirmation message that your request has been submitted before hitting the "submit" button again. There may be a slight delay before you receive this message. If you do not receive a confirmation message after 1 minute, please use the PDF version of the form. 
Outreach Request Form