CCU Counseling Center Services Request

Larry J. Crabb Center for University Counseling

Counseling Services Request
Thank you for reaching out to the CCU Counseling Center. We proudly serve students of the College of Undergraduate Studies. Students may inquire about clinical mental health services by completing a counseling request form. Counseling requests are reviewed as quickly as possible. Please do not submit multiple requests. You will be contacted by email regarding eligibility for campus counseling services through email. Check your email frequently and respond in a timely manner.

If you are in need of immediate support please call or text 988 to reach the 988 Lifeline. You may also visit the Colorado Crisis Center at 4643 Wadsworth Boulevard, Wheat Ridge, CO 80033.

In a true emergency, call 911.
Do you confirm you are currently enrolled full time in the College of Undergraduate Studies?*

YesNo
Full Name*

First NameLast Name
Gender*

FemaleMale
Date of Birth*

MonthDayYear
Date
Cell Phone*
Format: (000) 000-0000.
E-mail*
example@example.com
I agree to be contacted by phone and email regarding scheduling appointments.*

Yes
Please identify your housing situation:*

Off CampusDuplexesEast Campus ApartmentsHarwood HallPeaks Apartments - Kit CarsonPeaks Apartments - La PlataPeaks Apartments - Red CloudPeaks Apartments - SnowmassRockmont HallWaite HallYetter Hall
Campus Apartment Number or Off Campus Address:*
What year are you at CCU?*

FreshmanSophomoreJuniorSenior5th Year Senior
When do you anticipate graduating from CCU?*

May 2026December 2026May 2027December 2027May 2028December 2028May 2029December 2029
Please identify your academic major:*

AccountingApologetics and EvangelismBiblical Exegesis and LinguisticsBiblical Studies with LanguagesBiologyBusiness AdministrationClassical EducationCommunicationCommunication Information SystemsComputer ScienceCriminal Justice Law & PracticeElementary EducationEngineering Project ManagementEnglishEntrepreneurshipFinanceGlobal StudiesHealth SciencesHistoryIndustrial and Systems EngineeringKinesiology and Exercise ScienceLiberal ArtsManagementMarketingMinistry ManagementMusicMusic CompositionMusic EducationMusic Media and MarketingMusic PerformanceMusic Production and EngineeringNursingOutdoor LeadershipPhilosophyPhysical EducationPoliticsPre-EngineeringPre-MedPre-Physical TherapyPre-Physician AssistantPsychologyPsychology Dual Enrollment Clinical Mental Health FocusScienceSecondary EducationSocial ScienceSpecial EducationSports ManagementStrategic CommunicationTeaching and LearningTheologyWorship ArtsYouth Ministry
Reason for requesting counseling (check all that apply):*

Adjusting to CollegeAddictive or Problem Behavior(s), i.e. gaming, pornography use, masturbationAnxietyADHD/Learning DifferencesDepressionEating and Body Image ConcernsGrief/LossHealthy Decision Making/Stress ManagementSocial/Relationship IssuesSubstance UseSuicidal Thoughts (If you are in crisis and need immediate support contact Colorado Crisis Services 844-493-8255 or text TALK to 38255 or contact the 988 Suicide and Crisis Lifeline by simply dialing 988)Other
Counseling appointments are scheduled on the hour for 45 minutes. If you require evening or weekend appointments we can assist you with identifying a community provider.

Please carefully consider your schedule and select the days and times you are available for appointments. Note that 11AM appointments are not available on Tuesdays and Thursdays as the Counseling Center is closed for Chapel.*

Rows	---- MON --	-- TUES --	-- WED --	-- THURS --	-- FRI ----
8am
9am
10am
11am
12pm
1pm
2pm
3pm
4pm

Should be Empty:

Larry J. Crabb Center for University Counseling