Student Counseling Referral Form - Counseling Center

Counseling Center - Student Referral Form

Please complete the following information and somone will repsond back to you within 24 business hours.

EMERGENCY SERVICES

In the event of an emergency in which you are unable to reach the Counseling Center, call 911 or the Georgia Crisis and Access Line at 1.800.715.4225, or immediately obtain safe transportation to the nearest hospital emergency room.

Personal Information

Date *

Full Name *

First Name

Last Name

Campus *

Phone Number *