Request Outreach

If you are interested in including PACS in your programming or would like to request a particular type of training, please fill out our Outreach Request Form. Please be sure to submit your request at least 2 weeks in advance to ensure that there is adequate time for scheduling and planning. Please note that PACS may not be able to fulfill all requests due to clinical demands during specific times of the academic year.?

If you have any additional questions about PACS��s outreach services, you may contact our Outreach Coordinator, Alyssa Hamilton, Psy.D. by calling 603-862-2090 (Relay NH: 1-800-735-2964).

We will attempt to honor your service request. However, due to availability of staff during the requested date(s)/time(s), we cannot guarantee every request. The likelihood of honoring your request is increased significantly if there are alternative days and times and if you submit the request at least two weeks in advance.

Department/Organization

Contact Person Name

Contact Person Email

Contact Person Phone with Extenstion (if applicable)

Type of Service

Presentation

Workshop

Other��

Presentation Topic(s) or Subject(s) (please be specific)

Topic or Subject of Workshop

Purpose of Requested Services (e.g., goals, what you hope to accomplish, needs of participants)

Location

We kindly ask that those requesting an outreach be responsible for arranging a location.

Preferred Date(s) and Time(s) of Service

First Option - Date & Time

Second Option - Date & Time

Third Option - Date & Time

Participant(s) Special Needs Requested:

Expected Composition of Participants (check all that apply)

Students

Faculty/Staff

Parents

Other��

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