Community Services Outreach Materials Request

Community Services Outreach Materials Request

(NU Community Counseling Center & Psychological Assessment Clinic)
Name

First NameLast Name
Email
example@example.com
DigitalPhysical Copies Picked up at the Pleasant Hill CampusPhysical Copies Mailed my address
⭐️ If you select "Digital", you may download the materials from this form before clicking submit. Look for this download icon.

Even though you do not need to submit this form in order to obtain the digital versions, please complete and submit it anyway to help us keep track of inquiries. Once you submit, you will also receive an email with digital copies of the Center and Psychological Assessment Clinic (PAC) flyers as well.
⭐️ If you select "Pick up at the Pleasant Hill Campus", we will reach out to you to confirm the date you plan to pick up your materials and you can pick them up at 100 Ellinwood Way, Pleasant Hill, CA 94523 at the front desk on the first floor during normal business hours. Check in with the Center Support Specialist, Diane Deguzman, or one of the security guards.
⭐️ If you select "Mailed to my address", you will be prompted to select how many copies of each flyer and/or post card you want and to share the address you would like them to be sent.
Please state the Address to mail materials to:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Community Counseling Center Flyer (downloadable)
If you want Community Counseling Center Flyers, enter the quantity you would like:
Psychological Assessment Clinic Flyers (downloadable)
If you want Psychological Assessment Clinic Flyers, enter the quantity you would like:
"Grounding Wheel" Postcard (downloadable)
If you want "Grounding Wheel" Postcards, enter the quantity you would like:
"Spiral Breathing" Postcard (downloadable)
If you want "Spiral Breathing" Postcards, enter the quantity you would like:
If you need these materials for a specific event, please include the event name and the date they will be needed below.

Please note that, depending on current inventory and the number of copies requested, printing may require 1–2 weeks.
Date Needed By (if applicable)

MonthDayYear
Date
Name or brief description of event or organization where these will be shared (if applicable).
Should be Empty: