Student counseling request form
Counseling sessions during remote engagement
Due to the Covid 19 protocols all counseling sessions are currently being offered virtually.
Student information
First Name *
Email *
Mobile phone no. *
Reg No. *
Campus *
Questions about ( please check all that apply) *
Preferred method of contact *
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 *
Never submit passwords through Google Forms.
This form was created inside of KCA University. Report Abuse