DU Athletics Team/Group Sport Psych Services Request Form

DU Athletics Sport Psych Team Consultation, Presentation, & Workshop Request Form

*Any information provided in this form is not considered HIPAA compliant, confidential, or encrypted.*
Services are available to currently rostered intercollegiate student-athletes and teams. Please, do not use this form for emergency or urgent communication/requests. If you are in crisis, call 911, Campus Safety (303-871-3000) or contact DU's 24 Hour Crisis Line (303-871-2205).
Examples of team consultation and workshop/presentation topics include: Team Cohesion/Dynamics, Leadership, Communication, Confidence, Motivation, Performance Routines, Focus, Self-Talk, Relaxation/Recovery/Sleep
Student-athlete Name:*

First NameLast Name
Date of Birth*

MonthDayYear
Date
DU Email*
Simone.Biles@du.edu
Preferred Phone Number*
Please enter a valid phone number.
Sport*

Women's BasketballMen's BasketballWomen's GolfMen's GolfGymnasticsHockeyWomen's LacrosseMen's LacrosseSkiingWomen's SoccerMen's SoccerWomen's Swimming/DiveMen's Swimming/DiveWomen's TennisMen's TennisTriathlonVolleyball
Please describe the Sport Psych consultation, presentation, workshop, or event that you are requesting. Please provide all of the following: general and specific topics or skills, idea of time length of presentation (e.g., 60 or 90 minutes), preferred location, if you would like this to be open to only student-athletes on your team or student-athletes from other teams as well:

Please indicate the times you believe you and other interested student-athletes may be available for this presentation or workshop or event this academic quarter:*

	8 AM - 11 AM	11 AM - 2 PM	2 PM - 5 PM	After 5 PM
Monday
Tuesday
Wednesday
Thursday
Friday

Additional Comments / What I want the sport psych team to know before the event/start of services:
When Will I Hear Back?

A sport psych staff member will email you back within 3 business days, Monday - Friday. We do not check requests on weekends or holiday breaks. We make every effort to be as timely as possible in scheduling, however there may be occasions where we get delayed. All student-athletes can also make requests of the Sport Psych team directly through their athletic trainer at anytime, which may be faster.
Please be aware that by submitting this sign-up form, you are NOT entering into a professional relationship of any kind with a sport psychology professional.*

"I understand."
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DU Athletics Sport Psych Team Consultation, Presentation, & Workshop Request Form

Services are available to currently rostered intercollegiate student-athletes and teams. Please, do not use this form for emergency or urgent communication/requests. If you are in crisis, call 911, Campus Safety (303-871-3000) or contact DU's 24 Hour Crisis Line (303-871-2205).

Examples of team consultation and workshop/presentation topics include: Team Cohesion/Dynamics, Leadership, Communication, Confidence, Motivation, Performance Routines, Focus, Self-Talk, Relaxation/Recovery/Sleep