Requesting Counseling / Social Work Services
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Email address
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Your email
In case of an emergency, do NOT wait for a response. Contact 911 immediately. Response from WAVE staff may take between 24-72 hours. All information is confidential.
Student's name that you are concerned about (yourself or someone else).
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Your answer
Name of the person completing this form.
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Your answer
A description of your concern (please include all relevant information).
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Your answer
Best way for us to contact you (phone number, email address)
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Your answer
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