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Name: CSUN ID#: Sex: Male Female
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:
Cell: Residential: Work: Other:
(Please list in order of preference)
If your schedule doesn't fit with these specific group dates/times, would you then be interested in a general counseling support group?
Monday: Tuesday: Wednesday: Thursday: Friday:
(Check all that apply)
Counseling Services Class Presentation Daily Sundial
LocationBayramian Hall 52018111 Nordhoff StreetNorthridge, CA 91330-8217(818) 677-2366, Option email@example.com
HoursMonday-Friday: 8 a.m.-5 p.m.
For after hours, urgent care assistance(818) 677-2366, Option 3
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University Counseling Services
© California State University, Northridge
18111 Nordhoff Street, Northridge, CA 91330
Phone: (818) 677-1200
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