To submit a request for a member of the Counseling Center to speak to your class or organization, please fill out the form below.
Keep in mind that it takes time to schedule these visits, so requests should be made at least TWO WEEKS in advance.
All fields required unless noted.
Name of Event/Presentation (Optional)
Date(s) for Event/PresentationIn order to facilitate scheduling, please provide a range of dates/days if possible.
Time(s) of Event/Presentation
Location of Event
Expected Number Attending
Expected Length of Program (Optional)
If Other, please specify:
Additional Information (Optional)
Please submit completed form at least 14 days prior to event and we will do our best to meet your request.
Fraud, Waste, and Abuse Hotline
© 2007–17 Indiana University of Pennsylvania
1011 South Drive, Indiana, Pa. 15705 | 724-357-2100