Facebook Pixel Outreach Request Form | Western Kentucky University Skip to main content

Outreach Request Form


This form is used for students, faculty, or staff requesting a presentation to a classroom, organization, department, or WKU group. If you need to schedule a counseling appointment, please call the Counseling Center directly at: 270-745-3159.

When completing the request form,  please note we need at least two (2) weeks lead time to complete your request.

Role on campus:

College (if applicable)

Outreach Topic:

Are you requesting an interview with a staff member?

If you are requesting an interview will it be used for one of the following:

Are you requesting a specific staff member?

Length of Outreach:

Residence Hall:

Zoom (requestor is responsible to schedule zoom session and share link with the Counseling Center, PRIOR to the outreach)

Audio/Visual equipment available for the presentor:


Some of the links on this page may require additional software to view.

 Last Modified 9/21/21