COUNSELING SERVICES PRESENTATION REQUEST FORM
Please fill out the form and submit; you will be contacted once we receive your request.
Presentation Topic Wanted:
Expected Date for the presentation:
Expected Time of day/evening for the presentation:
(ex: 1:30-2:30 p.m.)
Name of class/group to whom this will be presented:
Number expected to attend (we request at least 10 participants)
Requested length of presentation:
Where the presentation will be held:
Name of Person making the request:
Briefly describe the purpose of the presentation:
Other pertinent information:
Contact phone us at 785-532-6927 or email us if questions.