Request for Counseling Services

At this point in the semester we are experiecing a high volume of students requesting counseling services and we have an ongoing waitlist. If you wish to proceed and be added to the waitlist, complete the form below. A Counseling & Wellness Center staff member will contact you within 48 hours to discuss the waitlist in more detail. If you would rather receive a list of community resources email Counseling.Wellness@untdallas.edu

Name *

Student ID *

Contact Preference *

E-mail

Phone

Email *

Phone Number

If necessary, may we leave a message identifying ourselves?

Yes

Age *

Are you currently enrolled in at least one class this semester? *

Note that if you are not currently enrolled in at least one class at UNT Dallas you will not be eligible for services. If you need assistance finding alternate resources email Counseling.Wellness@untdallas.edu

Yes

Are you in crisis? (Are you in immediate danger/harm to yourself or someone else?) *

If you are in immediate danger do not proceed with this form. Call 911 or get to your nearest hospital.

Yes

Statement of Problem *

Preferred Meeting Time(s) *

The Counseling Office is open Monday - Friday from 8:00am - 5:00pm.

How did you hear about Counseling services? *

If you have received services with us in the past, who was your counselor? *

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Request for Counseling Services