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Student Life Assistance Program

Confidential Online Request Form for Daily Living Issues


If you are experiencing a life-threatening situation, please call 911 or immediately go to an emergency room. If you are experiencing suicidal thoughts, homicidal thoughts, or domestic violence, DO NOT complete this form. Please contact your Assistance Program.


Use this form to request student/life resources and referrals that are uniquely designed to assist you. These items may include, but are not limited to, legal/financial, elder and child care, housing information, medical advocacy, coaching, personal assist services and more.

An Program representative will reach out to you within one business day with regard to your on-line request.


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Service Requester (Please remember that all of your information is confidential unless you request that we release information or in the event that you are a threat to yourself or someone else)
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Details
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