Name Description
We are interested in your perceptions of your experience with SIUE Counseling Services. When you are finished, please print and return the survey to front desk at Counseling Services. Please do not e-mail or fax the forms to Counseling Services.
If you are concerned about a student that you believe may be at risk of harm, or who may intend to harm others, please feel free to use this form to communicate your concern to someone at the university.
Please see our Training Opportunities for information about the practicum program. To complete an application for the practicum program, please submit two completed Recommendation Forms.
Authorization for release of confidential health information.
Optional Disclosure of Mental Health Information