Request Outreach Services

All UCI students, staff, faculty and community partners requesting CARE outreach services must complete an Outreach Request form (below). Due to the large number of requests for services, we must require a minimum of 10 audience members at each function. Requests received at least three (3) weeks in advance with at least 3 prioritized "choice" dates have a greater likelihood of being accommodated.

Workshop/Outreach Request Form

1) Contact Information

2) Audience and Service Details

Audience MembersCheck all that apply.




3) Topic Requested

General Topics

Relationships Topics

Sexual Assault


4) Date/Time Details

First Choice

Second Choice

Third Choice

  • mins
  • Yes
  • No

Will audio/visual equipment be provided? If yes:

5) Finish & Submit

  • Yes - profession/audience/group
  • No

Please note that it may take up to 10 days for us to respond to your workshop/training request.

If you do not hear from a staff member within that timeframe, please contact CARE at (949) 824-7273 or at

Thank you for your request! We look forward to working with you.