Program Request Form

Lewis University’s Center for Health and Counseling Services staff is available to do presentations, workshops, and trainings at your request on various health topics. If you are interested please complete the program request form.

Program request must be made at least 2 weeks prior to the requested program date. You will be notified of our availability within 3 business days of your request.

Please note: Availability is on a first-come, first-serve basis. If we are unavailable at your requested time we will work with you to find an alternative date. Also, if requesting a presentation, access to PowerPoint and the internet is required.

See Program Descriptions >> [Show Info]

Alcohol Education for Athletes
This workshop focuses on providing alcohol education and empowering athletes to reflect upon and create their team culture. Please note, this session requires 2 hour time commitment.

Alcohol Information and Safety Tips
We will provide you with information regarding alcohol consumption and how it can affect you and possibly consequence when consumed excessively. Information will also be provided regarding harm-reduction techniques.

Building Positive Self-Esteem and Confidence
In this workshop participants will learn about self-love and ways to create and maintain a positive sense of self.

Disordered Eating and Health Body Image
Topics will focus on problematic eating behaviors, eating disorders, and body image. Information is available for both male and female students.

Domestic Violence
Information will be provided regarding the signs of domestic violence within a relationship. Contact information for local and national helplines and support centers will be made available.

Drug Information and Safety
Information will be provided regarding drug use and the negative effects that it has on and individual.

General Health and Wellness
Topics under this workshop are broad introductions regarding your general health and how it affects your everyday living. Ways to make healthier choices in life are also discussed.

Grief and Loss
Various aspects of grief will be discussed including symptoms, stages, types of loss, coping skills, and how to help and support others.

Healthy Choices
This workshop focuses on providing education and facilitating discussion regarding topics such as alcohol, sexual assault & misconduct, consent, and ways to respond to challenging situations.

Healthy Communication
This workshop will discuss problematic and healthy communication styles and conflict resolution.


Healthy Relationships
This workshop discusses what a health relationship looks like. We will discuss positive communication techniques and also provide information the help you identify when a relationship may be unhealthy.

Men’s Health
Information will be provided on topics that are geared towards men. We will discuss current hot topics and men’s health, primary prevention methods for various cancers, and diseases that disproportionately affect men.

Nutrition
This workshop will cover the importance of healthy eating and how it relates to everyday life. Other topics that may be selected under this program are grocery shopping on a budget and meal planning.

Overview of Counseling Services
Counseling staff will provide an overview of services offered, intake process, how to make referrals and appointments, and other program offerings.

Physical Activity
Topics covered by this workshop include ways to increase physical activity in your daily life, the importance of physical activity and recommended levels of physical activity.

Sexual Assault & Consent
This workshop provides a comprehensive discussion about topics related to sexual assault and consent including relevancy to the college student population, the Lewis University sexual misconduct policy, bystander intervention, how to report an incident, and where to get support on and off campus. For more information regarding sexual assault, visit the LU Cares webpage.

Sexual Health
Information in this workshop will vary based on the requestors needs. Topics to consider sexually transmitted disease/infection information, information regarding HIV/AIDS, and information regarding STD/I testing.

Sleep Issues
This working will provide information regarding poor sleep habits. Attendees will learn how to wind down for the evening and improve sleeping skills.


Step Up! Bystander Intervention
Step UP! is a prosocial behavior and bystander intervention program that educates students to be proactive in helping others. The goals of Step UP! are to: raise awareness of helping behaviors, increase motivation to help, develop skills and confidence when responding to problems or concerns, ensure the safety and well-being of self and others.

Stress Management and Relaxation
Attendees will learn ways to decrease their stress levels. Information will also be provided about relaxation techniques and positive coping strategies

Suicide Prevention
This workshop will discuss signs of suicide and the steps and resources available on campus to assist those that may be at risk.

Support Survivors of Sexual Violence
Information will be provided on how to support those that are survivors of sexual violence. We will discuss the necessary steps to take when working with someone interested in reporting the incident and resources for those who are seeking further assistance.

Time Management
Information will be provided about the importance of time management. Attendees will learn ways to use their time more efficiently.

Women’s Health
Information will be provided on topics that are geared towards women. We will discuss current hot topics and women’s health, primary prevention methods for various cancers, and diseases that disproportionately affect women.



Applicant Information
*First Name:
 

*
Last Name:
 

*
Address:
 

*
City:
 

*
State:
 

*
Zip Code:
 

*
Phone Number:
 

*
Email:
 


Please provide information for an alternative contact
*Alternate First Name:
 

*
Alternate Last Name:
 

*
Alternate Email:
 

*
Alternate Phone Number:
 


*Requested Program Topic(s):


See Program Descriptions >> [Show Info]

Alcohol Education for Athletes
This workshop focuses on providing alcohol education and empowering athletes to reflect upon and create their team culture. Please note, this session requires 2 hour time commitment.

Alcohol Information and Safety Tips
We will provide you with information regarding alcohol consumption and how it can affect you and possibly consequence when consumed excessively. Information will also be provided regarding harm-reduction techniques.

Building Positive Self-Esteem and Confidence
In this workshop participants will learn about self-love and ways to create and maintain a positive sense of self.

Disordered Eating and Health Body Image
Topics will focus on problematic eating behaviors, eating disorders, and body image. Information is available for both male and female students.

Domestic Violence
Information will be provided regarding the signs of domestic violence within a relationship. Contact information for local and national helplines and support centers will be made available.

Drug Information and Safety
Information will be provided regarding drug use and the negative effects that it has on and individual.

General Health and Wellness
Topics under this workshop are broad introductions regarding your general health and how it affects your everyday living. Ways to make healthier choices in life are also discussed.

Grief and Loss
Various aspects of grief will be discussed including symptoms, stages, types of loss, coping skills, and how to help and support others.

Healthy Choices
This workshop focuses on providing education and facilitating discussion regarding topics such as alcohol, sexual assault & misconduct, consent, and ways to respond to challenging situations.

Healthy Communication
This workshop will discuss problematic and healthy communication styles and conflict resolution.


Healthy Relationships
This workshop discusses what a health relationship looks like. We will discuss positive communication techniques and also provide information the help you identify when a relationship may be unhealthy.

Men’s Health
Information will be provided on topics that are geared towards men. We will discuss current hot topics and men’s health, primary prevention methods for various cancers, and diseases that disproportionately affect men.

Nutrition
This workshop will cover the importance of healthy eating and how it relates to everyday life. Other topics that may be selected under this program are grocery shopping on a budget and meal planning.

Overview of Counseling Services
Counseling staff will provide an overview of services offered, intake process, how to make referrals and appointments, and other program offerings.

Physical Activity
Topics covered by this workshop include ways to increase physical activity in your daily life, the importance of physical activity and recommended levels of physical activity.

Sexual Assault & Consent
This workshop provides a comprehensive discussion about topics related to sexual assault and consent including relevancy to the college student population, the Lewis University sexual misconduct policy, bystander intervention, how to report an incident, and where to get support on and off campus. For more information regarding sexual assault, visit the LU Cares webpage.

Sexual Health
Information in this workshop will vary based on the requestors needs. Topics to consider sexually transmitted disease/infection information, information regarding HIV/AIDS, and information regarding STD/I testing.

Sleep Issues
This working will provide information regarding poor sleep habits. Attendees will learn how to wind down for the evening and improve sleeping skills.


Step Up! Bystander Intervention
Step UP! is a prosocial behavior and bystander intervention program that educates students to be proactive in helping others. The goals of Step UP! are to: raise awareness of helping behaviors, increase motivation to help, develop skills and confidence when responding to problems or concerns, ensure the safety and well-being of self and others.

Stress Management and Relaxation
Attendees will learn ways to decrease their stress levels. Information will also be provided about relaxation techniques and positive coping strategies

Suicide Prevention
This workshop will discuss signs of suicide and the steps and resources available on campus to assist those that may be at risk.

Support Survivors of Sexual Violence
Information will be provided on how to support those that are survivors of sexual violence. We will discuss the necessary steps to take when working with someone interested in reporting the incident and resources for those who are seeking further assistance.

Time Management
Information will be provided about the importance of time management. Attendees will learn ways to use their time more efficiently.

Women’s Health
Information will be provided on topics that are geared towards women. We will discuss current hot topics and women’s health, primary prevention methods for various cancers, and diseases that disproportionately affect women.



If you selected other, please describe the type of programming you are interested in:



Please enter the date and time of the requested program

*Program Date:


*Program Time:


Please provide an alternative date and time for requested program

*Alternate Program Date:
  

*Program Time:




*How long is the program (i.e. 1 hour)?
 

*Will we be expected to speak for the entire program?
 Yes
 No  

If you responded “no” to the previous answer, what is our time allotment?


*Please enter the location of your program. Include the building, room number and any special instructions that may be needed to gain entrance to the building



*How would you describe yourself?
 Student
 Faculty
 Staff  


*Is this presentation for a student organization?
 Yes
 No  

If yes, what is the name of the organization?




*What is the make-up of your audience (i.e. freshman, professors, athletes, etc.)?
 

*Expected Attendance
 


Please list any other special requests, questions, or concerns.


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