Honors College Peer-to-Peer Support Program
FOR YOU: Please complete this form with your name, contact information, and general availability so that we can match you with a Peer Support.

FOR A FRIEND: If you are referring a friend, roommate, or classmate to the program, please provide us with their name only.
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IF YOU ARE IN NEED OF IMMEDIATE HELP, PLEASE CALL 911 OR GO TO YOUR NEAREST EMERGENCY ROOM. You can also call the Kent State University Counseling and Psychological Services (CAPS) 24/7 Helpline at (330) 672-2487, and press Option #3.
Full Name *
Please enter your name OR the person's name whom you are referring to the program.
Email Address
Please enter the email address where we can reach you. If you are referring a friend, you can leave this blank.
Phone Number
Please enter the phone number where we can reach you. If you are referring a friend, you can leave this blank.
Your General Availability
Please select the days and times that you are generally available throughout the week. If you are referring a friend, you can leave this blank.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning (8am-12pm)
Afternoon (12pm-4pm)
Evening (4pm-8pm)
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