Student counseling request form
Counseling sessions during remote engagement
Due to the Covid 19 protocols all counseling sessions are currently being offered virtually.
Mobile phone no.
Questions about ( please check all that apply)
Am having suicidal thoughts
I have a diagnosed mental illness
I feel sad
Preferred method of contact
Face to Face
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
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
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This form was created inside of KCA University.