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Program Request Form

Thank you for your interest in requesting an educational program from the Lafayette College Counseling Center. We appreciate you taking the time to complete this form in order to help us support your event in the most effective and meaningful way possible.

Please note: Requests will be reviewed on a first come first serve basis. We require approximately one month advanced notice to allow staff to schedule and appropriately plan for requests. After submitting your request, you will be contacted by a member of the Counseling Center to schedule a time to meet in person and discuss your request. The Counseling Center reserves the right to decline participation in program requests that are not consistent with the Counseling Center’s mission.

Name & Organization:

Email & Telephone:

Proposed date/time/location of program:

Please indicate what topic you would like covered (you can visit our programs page to review our list of trainings and workshops previously offered.)

Who will be attending? (i.e. general student body, student group members)

What do you anticipate will be learned from this program?

What are possible approaches to achieve your intended goal?

How will you know that the program is successful and how will this be assessed?

Please list available dates and times to meet with the Counseling Center during our business hours Monday through Friday 8:45 am-5 pm.