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caps outreach request form
Contact Information
Your Name
Penn State Affiliation (check all that apply)
Undergraduate Student
Graduate Student
Faculty
Staff
Parent of Penn State Student
Alumni
Media
Local Community Member
Other…
Enter other…
Your Title/Role
Department/Group
Phone
Email
Has your group requested a CAPS program in the past?
Yes
No
What measures have you taken to address this topic with your group?
If steps have not yet been taken,
please offer
Life Hack Kits
,
Virtual Library videos
,
Red Folder Toolkit,
and other
Wellness Resources at CAPS
and
Health Promotion & Wellness
before continuing with this form.
Before you considered CAPS for this request, what other campus offices and/or local resources did you reach out to?
A list of recommended resources is available on the
Community Education & Outreach
website and the
Red Folder Campus Resources
website.
Presentation Request Details
Requested Date
Must be at least
three weeks
in the future for programs and
one week
for media interviews.
Requested Time
Requested Length (Minutes)
In-person programs must be at least 30 minutes.
Location
If in person is requested, is Zoom a possible back-up option, if required?
Yes
No
Audience Description
Number of Anticipated Attendees
Presentation Topic(s) Requested
Description of the program being requested
Other Information
If your request involves an interview-style format, include the
5 items for Media Interview Inquiries
here.
Information message
By clicking “Submit” I am acknowledging that I understand the CAPS outreach and interview guidelines and have
completed all steps related to making this request
.