EmailMeForm
Counseling & Accommodation Services Waitlist
Waitlist for Counseling
Name
*
First
Last
Student ID
*
ABAC Email
*
Phone
*
###
-
###
-
####
Preferred Counselor
*
Please select
First Available
Triniti Anderson
Shubha Chatterjee
Screening Questions
A description of the section goes here.
In the past two weeks, have you experienced thoughts of harming yourself or someone else?
*
Please select
Yes
No
In the last two months, have you experienced a traumatic event or significant loss?
*
Please select
Yes
No