Presentation Requests

If you or someone you know is experiencing a crisis, DO NOT use this form as a means of seeking help; call 954-424-6911 (Henderson Student Counseling Services) or 911.

Today's Date: A value is required. Invalid format. (i.e.12/15/2009)
Department Contact's Full Name:
A value is required. Minimum number of characters not met. Exceeded maximum number of characters.
(Note: The contact person is the person from your department who we should contact for purposes of scheduling)
Extension: (i.e. 21005) A value is required. Minimum number of characters not met. Exceeded maximum number of characters. Invalid format.
Email Address: A value is required. Invalid format.
Facilitator Name:
A value is required. Minimum number of characters not met. Exceeded maximum number of characters.
(Note: The facilitator is the person from your department who will be present for the presentation. The facilitator must be on site ½ hour before and during the presentation).
Facilitator Extension: (i.e. 21005) A value is required. Minimum number of characters not met. Exceeded maximum number of characters. Invalid format.

Preferred Presentation Date:
(Request at least 2 weeks in advance)

A value is required. Invalid format. (i.e.12/15/2009)
Start Time Requested:
(SVP presentations are 40-60 minutes in length for non-clinical groups and 60-95 minutes for clinical groups)
A value is required. Invalid format. (i.e. 12:30 or 04:00)
Presentation Location: Bldg:      A value is required.
Floor:     A value is required.
Room #: A value is required.
Audience: Clinical Students
Faculty
Non-Clinical Students
Staff Minimum number of selections not met.Maximum number of selections exceeded.
Academic Center: Please select an item.
Program:
Number of Participants: A value is required. Invalid format.
Type of Presentation Requested: Suicide and Violence Prevention
Stress Management
Other Minimum number of selections not met.Maximum number of selections exceeded.
 
Note: SVP presentations are facilitated through Power Point. You are responsible for providing the equipment required (i.e. computer and projector). If you have any questions, please email SVP or call (954) 262-5852.