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* 1. Employee Name

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* 2. Email Address

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* 3. Phone Number

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* 4. School/Department

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* 5. Counselling Services / Study Skills Workshops

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* 6. Special Requests- Please note that special requests might not fit within mandate

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* 7. Additional Information - Please provide information about the activity, the related course/program, and the approval for this activity, if applicable

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* 8. Date Required

Date
Time

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* 9. Location

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* 10. Location- Room Number

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* 11. Expected Number of Attendees

Thank you for submitting your request. We will respond within two (2) business days.

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