Outreach Program Request

We are receiving a high volume of requests at this time and sincerely appreciate your patience as we work to support the MSU community. Whenever possible, please submit requests 48 hours in advance of your event/need, to increase the possibility that we will be able to staff it. Please note that if you submit your request after 5pm, it may not be reviewed until the next business day.

Name of your Department/Program/Organization: Required info!

Your Name: We need to know who you are.

Position/Title/Role: This field is required.

Your Email Address: This field is required.

Your Phone Number: This field is required.

Date(s) of Event: We need the date(s).

Will this be an in-person, virtual or hybrid event? Please let us know if this will be an in-person-, virtual or hybrid event.

Day of Event Contact: Name, Phone, Email

Start and End Time for Event:

Tell us about your event and what you would like from us:

Anticipated Number and Description of Attendees: Please tell us the number of expected attendees and who they are.

If your group will have 25 or more people, please designate a moderator who will be present during the Outreach session. If it becomes necessary, the moderator should be prepared to help manage disruptions or redirect off-topic conversation so that other participants can get the most out of the Outreach presentation.

Please note that in order to create a safe space for dialogue and questions, recording is not allowed during Outreach sessions. Recording may be permitted if written consent is provided or if the host explicitly states that the session will be recorded and that by staying in the session, participants are consenting to the recording. Please discuss with an Outreach team member if you would like to record.

By checking this box I recognize and understand that my email address is provided solely for inquiries about CAPS and its outreach functions. I understand that this is not a form of contact for clinical treatment or help in emergency. If I do need clinical treatment I must call or visit the counseling center during office hours. If this is an emergency, please call 911 or MSU Campus Public Safety at 517.355.2221. Required