PCD Presentation/Training Request

Instructions

This form is intended to succinctly request members of the Personal Counseling Department to attend and/or present at meetings for the WCC campus community. Please note, filling out this form does not guarantee the Personal Counseling Department’s commitment to the proposed event. Using this form allows us to better keep track of requests and respond with efficiency. We appreciate you taking the time to fill it out and honoring our process!

Please submit a request at least 5 business days before the intended event.

This form IS NOT for emergency response or crisis intervention, nor to request an individual counseling appointment with a Personal Counselor. If you have concerns about your own or a student’s immediate health or safety, please contact emergency services right away.

Your Name (Preferred name accepted)* *

Your WCC Email address *

Today’s Date *

Position on Campus *

Department (if applicable) *

What presentation/ training are you requesting from the Personal Counseling Department? *

ASCC Supporting Students in Distress Training (1-hour Faculty/ Staff Training)

Help a Friend Training (1 hour Student Training)

Discussion of Services to Class (10- 20 mins)

Discussion of Services to Student Club/Organization (10-20 mins)

Partnering on a Campus Event for Students

Partnering on a Campus Event for Faculty/Staff

Partnering on a Campus Event for Alumni

Presence at Meeting

Other

If you chose other above, please specify.

What is the Purpose of the Event/ Meeting? *

Approximately How Many People Will Be in Attendance? *

Date of Event *

Time of Event *

Anything else we should know about? *

I acknowledge that this is NOT a Student Referral Form or Appointment Request Form *

Yes

Instruction *

Yes

This form is not for emergency response or crisis intervention. If you have concerns about your own or a student’s immediate health or safety, please contact emergency services right away. Emergency services include, but are not limited to: Call 911 or Go to your closest Emergency Room/ National Suicide Prevention Lifeline – 1-800-273-TALK (8255) (24/7)/ Crisis Text Line – Text HELLO to 741-741 (24/7)*

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