University Counseling Center - Student Request for Mental Health Information for Course Assignments or Other Projects
To submit an information request for a course assignment or other project, please complete the form below. The Outreach Coordinator will contact you within two business days to confirm receipt of your request and to ask any further questions, if needed. You will then be contacted when a member of the UCC has been identified to meet your request for information. (Please note: Clinical responsibilities take priority for our counselors, and the UCC may not be able to honor all requests. Generally, the UCC cannot guarantee to fulfill a request if given less than two weeks notice.)
Contact Information
Student's Name
Your answer
Phone Number
Your answer
Email
Your answer
Request Details
Nature of Request (Paper, Campus Newspaper Article, Etc.)
Your answer
Name of Professor
Your answer
Department
Your answer
Title of Class
Your answer
Topic ( Describe in detail.)
Your answer
Date Student Needs Information By
MM
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DD
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YYYY
Interview Style Preference
Please list days and times you are available to meet/discuss project.
Your answer
Submit
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