Center for Students in Recovery Workshop Request

To provide outreach and education to the UT Arlington community, the Center for Students in Recovery provides presentations about the CSR. If you would like to have a specific type of presentation tailored for a class or organization, please email csr@uta.edu.

Please complete the request form at least 2 weeks in advance of your requested date.

Contact Person Contact Person * First Last
Contact Phone Contact Phone * - ### - ### ####
Contact Email Address *
Name of Organization or Class Requesting the Workshop *
First Choice for Date First Choice for Date * / MM / DD YYYY
First Choice for Time First Choice for Time * : HH MM AM/PM
Second Choice for Date Second Choice for Date / MM / DD YYYY
Second Choice for Time Second Choice for Time : HH MM AM/PM
Workshop Location *
Anticipated Number of Students *
Time Allocated for Presentation *
Type of Equipment Available in Room *
Additional Information Needed for Workshop
How did you hear about the Center for Students in Recovery? Please select all that apply. *

How did you hear about the Center for Students in Recovery? Please select all that apply. Friend / Classmate / Peer UT Arlington Faculty / Staff Flyer / Poster Newsletter Event / Tabling Social Media Website Word of Mouth Other (Please explain in the line below)
Other (Please specify)