Request an Outreach Presentation/Program

Counseling Center
Ball State University
Lucina Hall, Room 320
Muncie, IN 47306
Phone: (765) 285-1736
Fax: (765) 285-2081
jmccoy@bsu.edu

Outreach Presentation/Program Request

Please submit your request at least two weeks in advance. We will confirm your request by phone or email.

Items with an * indicate a required field.

Contact Info
First Name *
Last Name *
Phone *
Email *
BSU Department *


Presentation/Program Info
Presentation/Program Title *
For a complete description of the program, please refer to the Outreach and Special Programs Guide
Class/Organization Name *
Date of Presentation/ Program *
Please select a second and third choice date if possible. We will confirm the date with you.
Second Choice Date
Third Choice Date
Time *
Location *
Est. Attendance *