Counseling Appointment Request

Student ID Number*

Name*

First Last

Phone*

WSU Email Address*

What program and cohort year are you in (e.g., Pharmacy year 1, Nursing J2, Medicine year 3, NEP Senior, etc.)?

Where will you be physically located during your counseling appointments (City and State)?

List your availability (days/times):*

Would you prefer a Zoom or Phone Session (choose only one)?*

Will you need a space on campus for your virtual appointment?

Please Select Counselor Preference (If no preference, select 'no preference')*

What is your priority in regards to scheduling?

Counseling Appointment Request Form