UR Medicine / Employee Assistance Program / Workshops & Training / Workshop/Training Request Form

Workshop/Training Request Form

We request at least four weeks of notice for requests. Any requests received less than four weeks before the requested date cannot be guaranteed. When an EAP counselor is assigned to a presentation, he/she/they will reach out to the requester no less than 24 hours in advance of the presentation time to finalize the number of attendees and the contents of the presentation.

Company Information Company Name:

Presentation Location:

Directions to Company/Department:

Contact Information Contact Name:

Contact Phone Number:

( ) -

Contact Email Address:

Presentation Details Requested Date/Time of Presentation (Please Allow 30 Days Notice):

Now

Alternative Date(s)/Time(s):

Workshop/Training Audience:

EmployeesSupervisors

Reason for Presentation/Desired Outcomes:

Number of Attendees:

Mandatory for Staff:

YesNo

Method for Staff Notification:

Equipment Available for Use:

No Equipment NeededLaptopProjectorOther

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