Student counseling request form
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Counseling sessions
You can choose to have your counseling sessions physically or virtually.
Student information
First Name *
Email *
Mobile phone no. *
Reg No. *
Campus *
Questions about ( please check all that apply) *
Required
Preferred mode of session *
Required
Please write the available time you would like to be contacted/ see a counselor Monday -Friday 9am-5pm *
Time windows are not a guaranteed appointment, however your selection helps us target the most likely time when you will be able to take the call
Please note we will respond to your request in 1-2 working days depending on the volume of requests received
Confidentiality
Please note while counseling sessions are confidential we can not ensure confidentiality of information given online due to the nature of the Internet and email technology.
I have read and understood the confidentiality statement *
Submit
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