CAPS Promotion and Outreach Request Form
***PLEASE NOTE*** In order to ensure we can do our best to meet your request needs, please complete this form at least 14 business days prior to the requested date so our staff can work to secure a trained facilitator for your class or student organization. Completing this form does not guarantee all requests can be fulfilled. If you are in need of an outreach event with LESS than 14 business days notice, please contact the CAPS Outreach Coordinator at kristin.zaccaro@unlv.edu.
Today's Date:
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Requester Name:
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First Name
Last Name
UNLV e-mail:
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Phone number:
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Type of Request:
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Please Select
Tabling Event
Workshop
Presentation
Speaker
Secondary Staff
Number of Anticipated Guests:
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Date (or Anticipated Date) of Event
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Month
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Day
Year
Date
If you do NOT have a specific date, please list possible dates and times you would like CAPS to consider
Time of Event
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Minutes
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AM/PM Option
Until
until
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Location of Event
Name of class, organization, department, etc. (If an academic class please use the following format: BUS 103, section 1001)
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Event Logistics
Will you have technology available for us (computer, projector, sound, etc)?
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Yes
No
Other
Requested Topic Area
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Depression
Anxiety
College Adjustment
Substance Use
Time Management
Studying for Finals
Other
If Other, Please Specify (with as much Detail as Possible):
Additional Information We Should Know?
Please review this form for accuracy, then enter text as shown to submit your request:
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Submit Form
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