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Quicklinks

Services Navigation

Contacting Me

I give permission for UCS to contact me (or leave a message) by the following means. I am aware that information exchanged over a cell phone and email could be intercepted by an outside party

Okay to call or leave a message if I am unavailable at:

Phone Numbers:

Cell:    Residential:

Work:    Other:

E-mail:

Groups I'm Interested in Attending:

(Please list in order of preference)

1)

2)

3)

If your schedule doesn't fit with these specific group dates/times, would you then be interested in a general counseling support group?

Yes No

Hours Available This Semester:

Monday:   Tuesday:   Wednesday:

Thursday:   Friday:

How did you find out about UCS Groups?

(Check all that apply)

Brochure Campus Fair Counseling Services Class Presentation

Daily Sundial Faculty Flyer/Mailer Friend Website

Other:

Referring Counselor: